Ilgar Mehtap, Elmalı Muzaffer, Nural Mehmet Selim
Department of Radiology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey.
Ulus Travma Acil Cerrahi Derg. 2013 Jan;19(1):33-40. doi: 10.5505/tjtes.2013.44538.
In this study, we investigated the role of abdominal computed tomography (CT) in determining perforation findings and site in patients with gastrointestinal tract perforation.
Preoperative abdominal CT scans of 47 patients who had surgically proven gastrointestinal tract perforation between July 2007 and July 2010 were reviewed retrospectively. The presence of free air, leakage of contrast material, wall thickness, wall discontinuity, abscess, free fluid, and phlegmon were investigated for each patient. The site of perforation was estimated in light of these findings and compared with the surgical outcomes.
Perforation sites were determined correctly in 85.7% of patients with gastroduodenal perforation, 85.7% of patients with small bowel perforation, 69.2% of patients with large bowel perforation, 100% of patients with rectum perforation, 90.9% of patients with appendix perforation, and 82.9% of all patients according to the abdominal CT findings. The most common CT finding in gastrointestinal tract perforation was free fluid, with a rate of 89.4%. The rates of other findings were as follows: free air 76.6%, segmental wall thickening 48.9%, wall discontinuity 25.5%, abscess 12.8%, and phlegmon 10.6%. Of 30 patients who received oral contrast, 7 (23.3%) had extraluminal contrast leakage.
CT is very effective in determining gastrointestinal tract perforation findings and the site of perforation.
在本研究中，我们调查了腹部计算机断层扫描（CT）在确定胃肠道穿孔患者的穿孔表现及部位方面的作用。
回顾性分析2007年7月至2010年7月间47例经手术证实为胃肠道穿孔患者的术前腹部CT扫描结果。对每位患者检查是否存在游离气体、造影剂渗漏、肠壁厚度、肠壁连续性中断、脓肿、游离液体及蜂窝织炎。根据这些检查结果估计穿孔部位，并与手术结果进行比较。
根据腹部CT检查结果，胃十二指肠穿孔患者中85.7%的穿孔部位判断正确，小肠穿孔患者中85.7%判断正确，大肠穿孔患者中69.2%判断正确，直肠穿孔患者中100%判断正确，阑尾穿孔患者中90.9%判断正确，所有患者中82.9%判断正确。胃肠道穿孔最常见的CT表现是游离液体，发生率为89.4%。其他表现的发生率如下：游离气体76.6%，节段性肠壁增厚48.9%，肠壁连续性中断25.5%，脓肿12.8%，蜂窝织炎10.6%。在30例接受口服造影剂检查的患者中，7例（23.3%）出现造影剂管腔外渗漏。
CT在确定胃肠道穿孔表现及穿孔部位方面非常有效。
