Gastrointestinal perforation CT: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
No edit summary
Line 6: Line 6:


=== Chest CT ===
=== Chest CT ===
* When fluoroscopy is equivocal, and there is persisting suspicion of perforation.  
* When [[fluoroscopy]] is equivocal, and there is persisting suspicion of perforation. 2, 4  
* extraluminal gas locules in the mediastinum or abdominal cavity, adjacent to the esophagus are highly suggestive 2, 4
* [[Pleural cavity|Pleural]] or [[Mediastinum|mediastinal]] fluid
* pleural or mediastinal fluid
* [[Pneumomediastinum]] or [[pneumothorax]]
* pneumomediastinum or pneumothorax
* pericardial or pleural effusions can be seen Water soluble oral contrast can be administered 20 minutes before scanning to demonstrate extravasation. Intravenous contrast is usually administered to delineate the oesophageal wall (25 - 60-second delay) 8.


=== Abdominal CT ===
=== Abdominal CT ===
* Signs of perforation on abdominal CT scanning include extraluminal air (image 6); extraluminal oral contrast; free fluid or food collections; and discontinuity of the intestinal wall, fistula, or intra-abdominal abscess often associated with irregular adjacent bowel wall thickening [82,93,99,100].
* Signs of perforation on abdominal CT scanning include:
* this is the primary imaging modality for detection and localization of bowel perforation
* Extraluminal oral contrast
* the site of the perforation can often be localized by:
* free fluid or food collections
* tracking the bubbles of pneumoperitoneum toward a region of the bowel
* discontinuity of the intestinal wall
* looking for localized peritoneal fat stranding or bowel wall thickening o determining a site of bowel wall discontinuity
* localized peritoneal fat stranding  
* if the patient received oral contrast, then often the leak can be seen directly as contrast spills out of the perforation site
* bowel wall thickening
* if a suspected bowel perforation is the primary indication for the study, then protocolling the study with a water-soluble contrast medium is useful
* oral contrast, then often the leak can be seen directly as contrast spills out of the perforation site
* if a bowel perforation occurs due to obstruction, the perforation usually occurs at the site of maximal bowel distention and the perforation may be distant from the actual cause of the bowel obstruction
* fistula
* a bowel perforation may not result in pneumoperitoneum, but liquid contents exiting the bowel may form a phlegmon or abscess
* intra-abdominal abscess
* [82,93,99,100].


==References==
==References==

Revision as of 17:30, 29 December 2017


[{CMG}}; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[1]

Overview

Chest CT

Abdominal CT

  • Signs of perforation on abdominal CT scanning include:
  • Extraluminal oral contrast
  • free fluid or food collections
  • discontinuity of the intestinal wall
  • localized peritoneal fat stranding
  • bowel wall thickening
  • oral contrast, then often the leak can be seen directly as contrast spills out of the perforation site
  • fistula
  • intra-abdominal abscess
  • [82,93,99,100].

References

Retrieved from "https://www.wikidoc.org/index.php?title=Gastrointestinal_perforation_CT&oldid=1426158"