Evolution of imaging for abdominal perforation

Ann R Coll Surg Engl. 2010 Apr;92(3):182-8. doi: 10.1308/003588410X12664192075251.


Introduction: Gastrointestinal (GI) perforation is a common surgical presentation. In recent years, computed tomography (CT) has been shown to be accurate for predicting the site of GI perforation, and has become the investigation of choice. However the signs may be subtle or only indirectly related to the site or aetiology of perforation.

Subjects and methods: A MEDLINE and PubMed search was performed for journals before June 2009 with MeSH major terms 'CT' and 'perforation'. Non-English speaking literature was excluded.

Results: Examples of GI perforation of various aetiologies are reviewed (inflammatory, neoplastic, traumatic and iatrogenic) high-lighting characteristic CT appearances as well as pitfalls in diagnosis. Features of perforation include the presence of free gas or fluid within the supra- and/or inframesocolic compartments, segmental bowel wall thickening, bowel wall discontinuity, stranding of the mesenteric fat and abscess formation.

Conclusions: These differentiating features facilitate accurate multidisciplinary pre-operative evaluation, necessary to plan patient management and potential surgical approach.

Publication types

  • Review

MeSH terms

  • Colonic Diseases / diagnostic imaging
  • Duodenal Diseases / diagnostic imaging
  • Esophagogastric Junction / diagnostic imaging
  • Humans
  • Intestinal Perforation / diagnostic imaging*
  • Intestine, Small / diagnostic imaging
  • Stomach Diseases / diagnostic imaging
  • Tomography, X-Ray Computed / methods