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Abdominal Radiology

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01.08.2014 | Review Paper

From esophagus to rectum: a comprehensive review of alimentary tract perforations at computed tomography

verfasst von: Andrew J. Del Gaizo, Chandana Lall, Brian C. Allen, John R. Leyendecker

Erschienen in: Abdominal Radiology | Ausgabe 4/2014

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Abstract

Gastrointestinal (GI) tract perforation is a life-threatening condition that can occur at any site along the alimentary tract. Early perforation detection and intervention significantly improves patient outcome. With a high sensitivity for pneumoperitoneum, computed tomography (CT) is widely accepted as the diagnostic modality of choice when a perforated hollow viscus is suspected. While confirming the presence of a perforation is critical, clinical management and surgical technique also depend on localizing the perforation site. CT is accurate in detecting the site of perforation, with segmental bowel wall thickening, focal bowel wall defect, or bubbles of extraluminal gas concentrated in close proximity to the bowel wall shown to be the most specific findings. In this article, we will present the causes for perforation at each site throughout the GI tract and review the patterns that can lead to prospective diagnosis and perforation site localization utilizing CT images of surgically proven cases.

Espinoza R, Rodriguez A (1997) Traumatic and nontraumatic perforation of hollow viscera. Surg Clin N Am 77(6):1291–1304PubMedCrossRef

Bohnen JM, Mustard RA, Oxholm SE, Schouten BD (1988) APACHE II score and abdominal sepsis. A prospective study. Arch Surg 123(2):225–229PubMedCrossRef

Christou NV, Barie PS, Dellinger EP, Waymack JP, Stone HH (1993) Surgical Infection Society intra-abdominal infection study. Prospective evaluation of management techniques and outcome. Arch Surg 128(2):193–198 (discussion 198–199)PubMedCrossRef

Hainaux B, Agneessens E, Bertinotti R, et al. (2006) Accuracy of MDCT in predicting site of gastrointestinal tract perforation. AJR Am J Roentgenol 187(5):1179–1183PubMedCrossRef

Stapakis JC, Thickman D (1992) Diagnosis of pneumoperitoneum: abdominal CT vs. upright chest film. J Comput Assist Tomogr 16(5):713–716PubMedCrossRef

Earls JP, Dachman AH, Colon E, Garrett MG, Molloy M (1993) Prevalence and duration of postoperative pneumoperitoneum: sensitivity of CT vs left lateral decubitus radiography. AJR Am J Roentgenol 161(4):781–785PubMedCrossRef

Kim SH, Shin SS, Jeong YY, et al. (2009) Gastrointestinal tract perforation: MDCT findings according to the perforation sites. Korean J Radiol 10(1):63–70PubMedCentralPubMedCrossRef

Yeung KW, Chang MS, Hsiao CP, Huang JF (2004) CT evaluation of gastrointestinal tract perforation. Clin Imaging 28(5):329–333PubMedCrossRef

Furukawa A, Sakoda M, Yamasaki M, et al. (2005) Gastrointestinal tract perforation: CT diagnosis of presence, site, and cause. Abdom Imaging 30(5):524–534PubMedCrossRef

10.

Ghekiere O, Lesnik A, Hoa D, et al. (2007) Value of computed tomography in the diagnosis of the cause of nontraumatic gastrointestinal tract perforation. J Comput Assist Tomogr 31(2):169–176PubMedCrossRef

11.

Brofman N, Atri M, Hanson JM, et al. (2006) Evaluation of bowel and mesenteric blunt trauma with multidetector CT. Radiographics 26(4):1119–1131PubMedCrossRef

12.

Miki T, Ogata S, Uto M, et al. (2004) Multidetector-row CT findings of colonic perforation: direct visualization of ruptured colonic wall. Abdom Imaging 29(6):658–662PubMedCrossRef

13.

Imuta M, Awai K, Nakayama Y, et al. (2007) Multidetector CT findings suggesting a perforation site in the gastrointestinal tract: analysis in surgically confirmed 155 patients. Radiat Med 25(3):113–118PubMedCrossRef

14.

Maniatis V, Chryssikopoulos H, Roussakis A, et al. (2000) Perforation of the alimentary tract: evaluation with computed tomography. Abdom Imaging 25(4):373–379PubMedCrossRef

15.

Zissin R, Konikoff F, Gayer G (2006) CT findings of latrogenic complications following gastrointestinal endoluminal procedures. Semin Ultrasound CT MR 27(2):126–138PubMedCrossRef

16.

Zissin R, Osadchy A, Gayer G (2009) Abdominal CT findings in small bowel perforation. Br J Radiol 82(974):162–171PubMedCrossRef

17.

Becker CD, Mentha G, Schmidlin F, Terrier F (1998) Blunt abdominal trauma in adults: role of CT in the diagnosis and management of visceral injuries. Part 2: gastrointestinal tract and retroperitoneal organs. Eur Radiol 8(5):772–780PubMedCrossRef

18.

Chen CH, Huang HS, Yang CC, Yeh YH (2001) The features of perforated peptic ulcers in conventional computed tomography. Hepatogastroenterology 48(41):1393–1396PubMed

19.

Fultz PJ, Skucas J, Weiss SL (1992) CT in upper gastrointestinal tract perforations secondary to peptic ulcer disease. Gastrointest Radiol 17(1):5–8PubMedCrossRef

20.

Young CA, Menias CO, Bhalla S, Prasad SR (2008) CT features of esophageal emergencies. Radiographics 28(6):1541–1553PubMedCrossRef

21.

Gimenez A, Franquet T, Erasmus JJ, Martinez S, Estrada P (2002) Thoracic complications of esophageal disorders. Radiographics 22(Spec No):S247–S258PubMedCrossRef

22.

Katabathina VS, Restrepo CS, Martinez-Jimenez S, Riascos RF (2011) Nonvascular, nontraumatic mediastinal emergencies in adults: a comprehensive review of imaging findings. Radiographics 31(4):1141–1160PubMedCrossRef

23.

Li ZS, Sun ZX, Zou DW, et al. (2006) Endoscopic management of foreign bodies in the upper-GI tract: experience with 1088 cases in China. Gastrointest Endosc 64(4):485–492PubMedCrossRef

24.

Mosca S, Manes G, Martino R, et al. (2001) Endoscopic management of foreign bodies in the upper gastrointestinal tract: report on a series of 414 adult patients. Endoscopy 33(8):692–696PubMedCrossRef

25.

Longstreth GF, Longstreth KJ, Yao JF (2001) Esophageal food impaction: epidemiology and therapy. A retrospective, observational study. Gastrointest Endosc 53(2):193–198PubMedCrossRef

26.

Webb WA (1995) Management of foreign bodies of the upper gastrointestinal tract: update. Gastrointest Endosc 41(1):39–51PubMedCrossRef

27.

Eisen GM, Baron TH, Dominitz JA, et al. (2002) Guideline for the management of ingested foreign bodies. Gastrointest Endosc 55(7):802–806PubMedCrossRef

28.

Ferguson MK (1997) Esophageal perforation and caustic injury: management of perforated esophageal cancer. Dis Esophagus 10(2):90–94PubMed

29.

Kim KR, Shin JH, Song HY, et al. (2009) Palliative treatment of malignant esophagopulmonary fistulas with covered expandable metallic stents. AJR Am J Roentgenol 193(4):W278–W282PubMedCrossRef

30.

Beal SL, Pottmeyer EW, Spisso JM (1988) Esophageal perforation following external blunt trauma. J Trauma 28(10):1425–1432PubMedCrossRef

31.

Brinster CJ, Singhal S, Lee L, et al. (2004) Evolving options in the management of esophageal perforation. Ann Thorac Surg 77(4):1475–1483PubMedCrossRef

32.

Stabile BE (1992) Current surgical management of duodenal ulcers. Surg Clin of N Am 72(2):335–356

33.

Grassi R, Romano S, Pinto A, Romano L (2004) Gastro-duodenal perforations: conventional plain film, US and CT findings in 166 consecutive patients. Eur J Radiol 50(1):30–36PubMedCrossRef

34.

Feliciano DV (1992) Do perforated duodenal ulcers need an acid-decreasing surgical procedure now that omeprazole is available? Surg Clin N Am 72(2):369–380PubMed

35.

Jordan PH Jr (1988) Morrow C: perforated peptic ulcer. Surg Clin N Am 68(2):315–329PubMed

36.

Donovan AJ, Berne TV, Donovan JA (1998) Perforated duodenal ulcer: an alternative therapeutic plan. Arch Surg 133(11):1166–1171PubMedCrossRef

37.

Felix EL, Kettelle J, Mobley E, Swartz D (2008) Perforated marginal ulcers after laparoscopic gastric bypass. Surg Endosc 22(10):2128–2132PubMedCrossRef

38.

Brunsting LA, Morton JH (1987) Gastric rupture from blunt abdominal trauma. J Trauma 27(8):887–891PubMedCrossRef

39.

Byun JH, Ha HK, Kim AY, et al. (2003) CT findings in peripheral T-cell lymphoma involving the gastrointestinal tract. Radiology 227(1):59–67PubMedCrossRef

40.

Cegarra-Navarro MF, de la Calle MA, Girela-Baena E, et al. (2005) Ruptured gastrointestinal stromal tumors: radiologic findings in six cases. Abdom Imaging 30(5):535–542PubMedCrossRef

41.

Chao TC, Chao HH, Jan YY, Chen MF (2005) Perforation through small bowel malignant tumors. J Gastrointest Surg 9(3):430–435PubMedCrossRef

42.

Hohenberger P, Ronellenfitsch U, Oladeji O, et al. (2010) Pattern of recurrence in patients with ruptured primary gastrointestinal stromal tumour. Br J Surg 97(12):1854–1859PubMedCrossRef

43.

Kim SW, Kim HC, Yang DM (1017) Perforated tumours in the gastrointestinal tract: CT findings and clinical implications. Br J Radiol 2012(85):1307–1313

44.

Roviello F, Rossi S, Marrelli D, et al. (2006) Perforated gastric carcinoma: a report of 10 cases and review of the literature. World J Surg Oncol 4:19PubMedCentralPubMedCrossRef

45.

Yang CJ, Hwang JJ, Kang WY, et al. (2006) Gastro-intestinal metastasis of primary lung carcinoma: clinical presentations and outcome. Lung Cancer 54(3):319–323PubMedCrossRef

46.

Jwo SC, Chien RN, Chao TC, Chen HY, Lin CY (2005) Clinicopathological features, surgical management, and disease outcome of perforated gastric cancer. J Surg Oncol 91(4):219–225PubMedCrossRef

47.

Shih CH, Yu MC, Chao TC, et al. (2010) Outcome of perforated gastric cancer: twenty years experience of one institute. Hepatogastroenterology 57(102–103):1320–1324PubMed

48.

Daliya P, White TJ, Makhdoomi KR (2012) Gastric perforation in an adult male following nasogastric intubation. Ann R Coll Surg Engl 94(7):e210–e212PubMedCentralPubMedCrossRef

49.

Enns R, Eloubeidi MA, Mergener K, et al. (2002) ERCP-related perforations: risk factors and management. Endoscopy 34(4):293–298PubMedCrossRef

50.

Merchea A, Cullinane DC, Sawyer MD, et al. (2010) Esophagogastroduodenoscopy-associated gastrointestinal perforations: a single-center experience. Surgery 148(4):876–880 (discussion 881–872)PubMedCrossRef

51.

Hines J, Rosenblat J, Duncan DR, Friedman B, Katz DS (2013) Perforation of the mesenteric small bowel: etiologies and CT findings. Emerg Radiol 20(2):155–161PubMedCrossRef

52.

Greenstein AJ, Mann D, Sachar DB, Aufses AH Jr (1985) Free perforation in Crohn’s disease: I. A survey of 99 cases. Am J Gastroenterol 80(9):682–689PubMed

53.

Berg DF, Bahadursingh AM, Kaminski DL, Longo WE (2002) Acute surgical emergencies in inflammatory bowel disease. Am J Surg 184(1):45–51PubMedCrossRef

54.

Freeman HJ (2002) Spontaneous free perforation of the small intestine in Crohn’s disease. Can J Gastroenterol 16(1):23–27PubMed

55.

Furukawa A, Saotome T, Yamasaki M, et al. (2004) Cross-sectional imaging in Crohn disease. Radiographics 24(3):689–702PubMedCrossRef

56.

Rha SE, Ha HK, Lee SH, et al. (2000) CT and MR imaging findings of bowel ischemia from various primary causes. Radiographics 20(1):29–42PubMedCrossRef

57.

Furukawa A, Yamasaki M, Takahashi M, et al. (2003) CT diagnosis of small bowel obstruction: scanning technique, interpretation and role in the diagnosis. Semin Ultrasound CT MR 24(5):336–352PubMedCrossRef

58.

Lowe RJ, Boyd DR, Folk FA, Baker RJ (1972) The negative laparotomy for abdominal trauma. J Trauma 12(10):853–861PubMedCrossRef

59.

Shanmuganathan K, Mirvis SE, Chiu WC, et al. (2004) Penetrating torso trauma: triple-contrast helical CT in peritoneal violation and organ injury: a prospective study in 200 patients. Radiology 231(3):775–784PubMedCrossRef

60.

Butela ST, Federle MP, Chang PJ, et al. (2001) Performance of CT in detection of bowel injury. AJR Am J Roentgenol 176(1):129–135PubMedCrossRef

61.

Breen DJ, Janzen DL, Zwirewich CV, Nagy AG (1997) Blunt bowel and mesenteric injury: diagnostic performance of CT signs. J Comput Assist Tomogr 21(5):706–712PubMedCrossRef

62.

Kako S, Oshima K, Sato M, Terasako K, et al. (2009) Clinical outcome in patients with small-intestinal non-Hodgkin lymphoma. Leuk Lymphoma 50(10):1618–1624PubMedCrossRef

63.

Balthazar EJ, Noordhoorn M, Megibow AJ, Gordon RB (1997) CT of small-bowel lymphoma in immunocompetent patients and patients with AIDS: comparison of findings. AJR Am J Roentgenol 168(3):675–680PubMedCrossRef

64.

Dodd GD 3rd, Greenler DP, Confer SR (1992) Thoracic and abdominal manifestations of lymphoma occurring in the immunocompromised patient. Radiol Clin N Am 30(3):597–610PubMed

65.

Ghai S, Pattison J, Ghai S, et al. (2007) Primary gastrointestinal lymphoma: spectrum of imaging findings with pathologic correlation. Radiographics 27(5):1371–1388PubMedCrossRef

66.

Lee WK, Lau EW, Duddalwar VA, Stanley AJ, Ho YY (2008) Abdominal manifestations of extranodal lymphoma: spectrum of imaging findings. AJR Am J Roentgenol 191(1):198–206PubMedCrossRef

67.

Levine MS, Rubesin SE, Pantongrag-Brown L, Buck JL, Herlinger H (1997) Non-Hodgkin’s lymphoma of the gastrointestinal tract: radiographic findings. AJR Am J Roentgenol 168(1):165–172PubMedCrossRef

68.

Kim SY, Ha HK, Park SW, et al. (2009) Gastrointestinal metastasis from primary lung cancer: CT findings and clinicopathologic features. AJR Am J Roentgenol 193(3):W197–W201PubMedCrossRef

69.

Goh BK, Tan YM, Lin SE, et al. (2006) CT in the preoperative diagnosis of fish bone perforation of the gastrointestinal tract. AJR Am J Roentgenol 187(3):710–714PubMedCrossRef

70.

Rathaus V, Erez I, Zissin R (2006) Ileal perforation due to an ingested fragment of a skewer: preoperative ultrasonographic diagnosis. J Ultrasound Med 25(3):389–391PubMed

71.

Bixby SD, Lucey BC, Soto JA, et al. (2006) Perforated versus nonperforated acute appendicitis: accuracy of multidetector CT detection. Radiology 241(3):780–786PubMedCrossRef

72.

Keyzer C, Zalcman M, De Maertelaer V, et al. (2005) Comparison of US and unenhanced multi-detector row CT in patients suspected of having acute appendicitis. Radiology 236(2):527–534PubMedCrossRef

73.

Lane MJ, Katz DS, Ross BA, et al. (1997) Unenhanced helical CT for suspected acute appendicitis. AJR Am J Roentgenol 168(2):405–409PubMedCrossRef

74.

Lane MJ, Liu DM, Huynh MD, et al. (1999) Suspected acute appendicitis: nonenhanced helical CT in 300 consecutive patients. Radiology 213(2):341–346PubMedCrossRef

75.

Rao PM, Rhea JT, Novelline RA, et al. (1997) Helical CT technique for the diagnosis of appendicitis: prospective evaluation of a focused appendix CT examination. Radiology 202(1):139–144PubMed

76.

Rao PM, Rhea JT, Novelline RA, Mostafavi AA, McCabe CJ (1998) Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. New Engl J Med 338(3):141–146PubMedCrossRef

77.

Rhea JT, Halpern EF, Ptak T, et al. (2005) The status of appendiceal CT in an urban medical center 5 years after its introduction: experience with 753 patients. AJR Am J Roentgenol 184(6):1802–1808PubMedCrossRef

78.

Foley TA, Earnest Ft, Nathan MA, et al. (2005) Differentiation of nonperforated from perforated appendicitis: accuracy of CT diagnosis and relationship of CT findings to length of hospital stay. Radiology 235(1):89–96PubMedCrossRef

79.

Horrow MM, White DS, Horrow JC (2003) Differentiation of perforated from nonperforated appendicitis at CT. Radiology 227(1):46–51PubMedCrossRef

80.

Lin CJ, Chen JD, Tiu CM, et al. (2005) Can ruptured appendicitis be detected preoperatively in the ED? Am J Emerg Med 23(1):60–66PubMedCrossRef

81.

Oliak D, Sinow R, French S, Udani VM, Stamos MJ (1999) Computed tomography scanning for the diagnosis of perforated appendicitis. Am Surg 65(10):959–964PubMed

82.

Yeung KW, Chang MS, Hsiao CP (2004) Evaluation of perforated and nonperforated appendicitis with CT. Clin Imaging 28(6):422–427PubMedCrossRef

83.

Brown CV, Abrishami M, Muller M, Velmahos GC (2003) Appendiceal abscess: immediate operation or percutaneous drainage? Am Surg 69(10):829–832PubMed

84.

Yamini D, Vargas H, Bongard F, Klein S, Stamos MJ (1998) Perforated appendicitis: is it truly a surgical urgency? Am Surg 64(10):970–975PubMed

85.

Misdraji J (2010) Appendiceal mucinous neoplasms: controversial issues. Arch Pathol Lab Med 134(6):864–870PubMed

86.

Lim HK, Lee WJ, Kim SH, et al. (1999) Primary mucinous cystadenocarcinoma of the appendix: CT findings. AJR Am J Roentgenol 173(4):1071–1074PubMedCrossRef

87.

Abdelrazeq AS, Scott N, Thorn C, et al. (2008) The impact of spontaneous tumour perforation on outcome following colon cancer surgery. Colorectal Dis 10(8):775–780PubMedCrossRef

88.

Kim SW, Shin HC, Kim IY, Kim YT, Kim CJ (2010) CT findings of colonic complications associated with colon cancer. Korean J Radiol 11(2):211–221PubMedCentralPubMedCrossRef

89.

Tan KK, Hong CC, Zhang J, Liu JZ, Sim R (2010) Surgery for perforated colorectal malignancy in an Asian population: an institution’s experience over 5 years. Int J Colorectal Dis 25(8):989–995PubMedCrossRef

90.

Fernandez-Esparrach G, Bordas JM, Giraldez MD, et al. (2010) Severe complications limit long-term clinical success of self-expanding metal stents in patients with obstructive colorectal cancer. Am J Gastroenterol 105(5):1087–1093PubMedCrossRef

91.

Humes DJ, Solaymani-Dodaran M, Fleming KM, et al. (2009) A population-based study of perforated diverticular disease incidence and associated mortality. Gastroenterology 136(4):1198–1205PubMedCrossRef

92.

Horton KM, Corl FM, Fishman EK (2000) CT evaluation of the colon: inflammatory disease. Radiographics 20(2):399–418PubMedCrossRef

93.

Oliphant M, Berne AS, Meyers MA (1996) The subperitoneal space of the abdomen and pelvis: planes of continuity. AJR Am J Roentgenol 167(6):1433–1439PubMedCrossRef

94.

Lohsiriwat V (2010) Colonoscopic perforation: incidence, risk factors, management and outcome. World J Gastroenterol 16(4):425–430PubMedCentralPubMedCrossRef

95.

Arora G, Mannalithara A, Singh G, Gerson LB, Triadafilopoulos G (2009) Risk of perforation from a colonoscopy in adults: a large population-based study. Gastrointest Endosc 69(3 Pt 2):654–664PubMedCrossRef

96.

Rabeneck L, Paszat LF, Hilsden RJ et al. (2008) Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice. Gastroenterology 135(6):1899–1906, 1906, e1891

97.

Kim DH, Pickhardt PJ, Taylor AJ, Menias CO (2008) Imaging evaluation of complications at optical colonoscopy. Curr Prob Diagn Radiol 37(4):165–177CrossRef

98.

Pickhardt PJ, Kim DH, Taylor AJ (2008) Asymptomatic pneumatosis at CT colonography: a benign self-limited imaging finding distinct from perforation. AJR Am J Roentgenol 190(2):W112–W117PubMedCrossRef

99.

Putcha RV, Burdick JS (2003) Management of iatrogenic perforation. Gastroenterol Clin N Am 32(4):1289–1309CrossRef

100.

Kurer MA, Davey C, Khan S, Chintapatla S (2010) Colorectal foreign bodies: a systematic review. Colorectal Dis 12(9):851–861PubMedCrossRef

101.

Barone JE, Yee J, Nealon TF Jr (1983) Management of foreign bodies and trauma of the rectum. Surg Gynecol Obstet 156(4):453–457PubMed

Titel: From esophagus to rectum: a comprehensive review of alimentary tract perforations at computed tomography
verfasst von: Andrew J. Del Gaizo
Chandana Lall
Brian C. Allen
John R. Leyendecker
Publikationsdatum: 01.08.2014
Verlag: Springer US
Erschienen in: Abdominal Radiology / Ausgabe 4/2014
Print ISSN: 2366-004X
Elektronische ISSN: 2366-0058
DOI: https://doi.org/10.1007/s00261-014-0110-4

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From esophagus to rectum: a comprehensive review of alimentary tract perforations at computed tomography

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