Gastrointestinal perforation other imaging findings
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
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Gastrointestinal perforation Microchapters |
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Differentiating gastrointestinal perforation from other diseases |
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Overview
Fluoroscopy
most sensitive within the first 24 hours 1
patient examined semi-supine on fluoroscopy table
a water-soluble agent should be used initially as barium can cause mediastinitis
oesophageal perforation may be represented as mucosal irregularity or gross extraluminal contrast extravasation
some authors suggest the use of small amounts of low or high concentrations of barium if no leak is evident on initial screening with water soluble contrast 8
Dye studies may be useful for evaluating patients with a pleural effusion and a thoracostomy tube who are suspected to have an esophageal leak. Methylene blue introduced cautiously via a nasoesophageal tube will make or confirm the diagnosis by causing blue discoloration of the chest tube drainage.
barium should not be used initially as an oral contrast agent because it can produce granulomas in the tissues if it leaks out
suspected gastroduodenal perforation
an upper GI study with water-soluble contrast medium is not usually the primary study for detection of a suspected gastric or duodenal perforation but can be useful for confirmation of an equivocal appearance on CT or for detection of the precise location of a small perforation
suspected small bowel perforation
small bowel follow through is inferior to CT of the abdomen and pelvis with oral contrast for detection and localization of small bowel perforation
suspected colonic perforation
single contrast barium enema is not usually appropriate in the setting of colonic perforation
the reason for colonic perforation is usually apparent and these patient are usually operated upon emergently