Grassi R, Di Mizio R, Pinto A, Cioffi A, Romano L, Rotondo A
Dipartimento di Emergenza, Ospedale A. Cardarelli, Napoli.
Radiol Med. 1996 Jun;91(6):747-55.
Plain abdominal radiography is the method of choice to diagnose gastrointestinal perforation because it shows the presence of free intraperitoneal air and of other associated radiologic signs. Recently, the modern methods of cross-section imaging, that is US and CT, have become useful tools for the accurate detection and depiction of free abdominal air, especially when plain films are normal or nonspecific. A series of 61 consecutive patients operated on for viscus perforation at Cardarelli Hospital, Neaples, was retrospectively reviewed: the authors report the site and cause of perforation and the diagnostic methods used preoperatively to recognize the radiographic sign of free air; examination time and the time passed between the first radiograph and surgery were also investigated. Of 61 patients, 53 underwent preoperative radiologic exams: plain abdominal radiographs were performed on 50 patients, abdominal US on 29 and CT on 15, while 8 patients were submitted to surgery with no previous diagnostic examination. Direct and indirect signs of perforation were assessed to compare the sensitivity of the methods and to suggest a possible diagnostic protocol. Combined radiography, US and CT showed signs of perforation in 71% of cases (direct signs in 57.5% and indirect signs, that is free intraperitoneal fluid and hypoperistalsis, in 14.5% of cases). When free air was absent (1/3 of cases), free intraperitoneal fluid was the only radiologic finding. The authors conclude that plain abdominal radiography, when correctly performed, is still the main tool permitting free air, if present, to be depicted in 100% of cases. When plain abdominal radiography is positive, other radiologic procedures are unnecessary while, when it is negative and symptoms persist, US and CT should be performed after at least 6 hours' interval to allow the radiologic picture to change markedly.
腹部平片是诊断胃肠道穿孔的首选方法，因为它能显示腹腔内游离气体及其他相关放射学征象。近来，现代横断面成像方法，即超声（US）和计算机断层扫描（CT），已成为准确检测和显示腹腔游离气体的有用工具，尤其是在腹部平片正常或不具有特异性时。对那不勒斯卡达雷利医院连续接受脏器穿孔手术的61例患者进行了回顾性研究：作者报告了穿孔部位、原因以及术前用于识别游离气体放射学征象的诊断方法；还调查了检查时间以及第一张X线片与手术之间的间隔时间。61例患者中，53例接受了术前放射学检查：50例患者进行了腹部平片检查，29例进行了腹部超声检查，15例进行了CT检查，而8例患者未进行术前诊断性检查即接受了手术。评估穿孔的直接和间接征象，以比较这些方法的敏感性并提出可能的诊断方案。联合使用X线摄影、超声和CT检查时，71%的病例显示有穿孔征象（直接征象占57.5%，间接征象，即腹腔内游离液体和蠕动减弱，占14.5%）。当没有游离气体时（1/3的病例），腹腔内游离液体是唯一的放射学表现。作者得出结论，正确进行的腹部平片检查仍然是在100%的病例中显示存在游离气体的主要手段。当腹部平片检查呈阳性时，无需进行其他放射学检查，而当检查结果为阴性且症状持续存在时，应至少间隔6小时后进行超声和CT检查，以使放射学表现有明显变化。
