Department of Radiology, Dokuz Eylul University Hospital, 35340, Izmir, Turkey.
Emerg Radiol. 2022 Feb;29(1):99-105. doi: 10.1007/s10140-021-01990-7. Epub 2021 Oct 11.
To evaluate the role of specific distributions of free air in predicting the location of gastrointestinal (GI) tract perforation.
One hundred and fifteen patients with surgically proven GI tract perforation between January 2015 and June 2019 were included in the study. The site of perforation was based on surgical findings in all cases. Two radiologists retrospectively interpreted the computed tomography (CT) images of these patients for extraluminal free air distribution. Perforation sites were demonstrated intraoperatively in all cases and were categorized as follows: stomach and duodenum, jejunum and ileum, proximal colon (cecum, ascending colon, and transverse colon), distal colon (descending colon and sigmoid colon), rectum, and appendix.
There were 79 male and 36 female patients with a mean age of 56.4 years. Periportal, perihepatic, and perigastric free air were statistically significant in predicting gastroduodenal perforation. Mesenteric free air was significant in predicting both small bowel and distal colon perforations. Pelvic free air was statistically significant in distal colon perforations. Periappendiceal free air was found to be a strong predictor of acute perforated appendicitis.
Specific free air distributions may help to predict the site of gastrointestinal perforation, which would change the treatment plan.
评估自由气腔的特定分布在预测胃肠道（GI）穿孔部位中的作用。
本研究纳入了 2015 年 1 月至 2019 年 6 月期间经手术证实的 115 例胃肠道穿孔患者。所有病例均根据手术发现确定穿孔部位。两位放射科医生对这些患者的 CT 图像进行回顾性解读，以评估游离气腔的分布。所有病例均在术中显示穿孔部位，并分为以下几类：胃和十二指肠、空肠和回肠、近端结肠（盲肠、升结肠和横结肠）、远端结肠（降结肠和乙状结肠）、直肠和阑尾。
患者中男性 79 例，女性 36 例，平均年龄为 56.4 岁。肝门周围、肝周和胃周游离气腔在预测胃十二指肠穿孔方面具有统计学意义。肠系膜游离气腔在预测小肠和远端结肠穿孔方面具有统计学意义。盆腔游离气腔在预测远端结肠穿孔方面具有统计学意义。阑尾周围游离气腔被发现是急性穿孔性阑尾炎的强预测指标。
特定的游离气腔分布可能有助于预测胃肠道穿孔的部位，从而改变治疗计划。
