Pouli Styliani, Kozana Androniki, Papakitsou Ioanna, Daskalogiannaki Maria, Raissaki Maria
Department of Radiology, University Hospital of Heraklion, Faculty of Medicine-University of Crete, Stavrakia, Voutes 21110, Heraklion, Crete, Greece.
Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Greece.
Insights Imaging. 2020 Feb 21;11(1):31. doi: 10.1186/s13244-019-0823-6.
Gastrointestinal tract (GIT) perforation is a common medical emergency associated with considerable mortality, ranging from 30 to 50%. Clinical presentation varies: oesophageal perforations can present with acute chest pain, odynophagia and vomiting, gastroduodenal perforations with acute severe abdominal pain, while colonic perforations tend to follow a slower progression course with secondary bacterial peritonitis or localised abscesses. A subset of patients may present with delayed symptoms, abscess mimicking an abdominal mass, or with sepsis.Direct multidetector computed tomography (MDCT) findings support the diagnosis and localise the perforation site while ancillary findings may suggest underlying conditions that need further investigation following primary repair of ruptured bowel. MDCT findings include extraluminal gas, visible bowel wall discontinuity, extraluminal contrast, bowel wall thickening, abnormal mural enhancement, localised fat stranding and/or free fluid, as well as localised phlegmon or abscess in contained perforations.The purpose of this article is to review the spectrum of MDCT findings encountered in GIT perforation and emphasise the MDCT and clinical clues suggestive of the underlying aetiology and localisation of perforation site.
胃肠道（GIT）穿孔是一种常见的医疗急症，死亡率相当高，在30%至50%之间。临床表现各不相同：食管穿孔可表现为急性胸痛、吞咽痛和呕吐，胃十二指肠穿孔表现为急性剧烈腹痛，而结肠穿孔往往进展较慢，伴有继发性细菌性腹膜炎或局部脓肿。一部分患者可能出现延迟症状、脓肿酷似腹部肿块或伴有败血症。多层螺旋计算机断层扫描（MDCT）的直接表现有助于诊断并确定穿孔部位，而辅助表现可能提示潜在疾病，在破裂肠管一期修复后需要进一步检查。MDCT表现包括肠腔外气体、可见的肠壁连续性中断、肠腔外造影剂、肠壁增厚、异常的壁强化、局部脂肪条索影和/或游离液体，以及局限性蜂窝织炎或局限性穿孔形成的脓肿。本文旨在综述GIT穿孔中MDCT表现的范围，并强调MDCT及提示潜在病因和穿孔部位定位的临床线索。
