title: Gastrointestinal tract perforation: evaluation of MDCT according to perforation site and elapsed time.
abstract: OBJECTIVE
  To evaluate multidetector computed tomography (MDCT) for the prediction of perforation site according to each gastrointestinal (GI) tract site and elapsed time.
  
  
  METHODS
  One hundred and sixty-eight patients who underwent MDCT before laparotomy for GI tract perforation were enrolled and allocated to an early or late lapse group based on an elapsed time of 7 h. Two reviewers independently evaluated the perforation site and assessed the following CT findings: free air location, mottled extraluminal air bubbles, focal bowel wall discontinuity, segmental bowel wall thickening, perivisceral fat stranding and localised fluid collection.
  
  
  RESULTS
  The overall diagnostic accuracy was 91.07 % and 91.67 % for reviewers 1 and 2, respectively, with excellent agreement (kappa 0.86). Accuracies (98.97 % and 97.94 %) and agreements (kappa 0.894) for stomach and duodenum perforation were higher than for other perforation sites. Strong predictors of perforation at each site were: focal bowel wall discontinuity for stomach, duodenal bulb and left colon, mottled extraluminal air bubbles for retroperitoneal duodenum and right colon, and segmental bowel wall thickening for small bowel. The diagnostic accuracy was not different between the early- and late-lapse groups.
  
  
  CONCLUSIONS
  MDCT can accurately predict upper GI tract perforation with high reliability. Elapsed time did not affect the accuracy of perforation site prediction.
  
  
  CONCLUSIONS
  Perforation of the stomach and duodenum can be accurately predicted with MDCT. Knowledge of CT findings predicting perforation site can improve diagnostic accuracy. Elapsed time does not significantly affect accuracy in predicting perforation sites.
authors.affiliation: Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, 149 Sangil-dong, Gangdong-gu, Seoul, 134-727, Republic of Korea, khcppp@khu.ac.kr.
authors.forename: Hyun Cheol
authors.initials: HC
authors.lastname: Kim
authors.forename: Dal Mo
authors.initials: DM
authors.lastname: Yang
authors.forename: Sang Won
authors.initials: SW
authors.lastname: Kim
authors.forename: Seong Jin
authors.initials: SJ
authors.lastname: Park
mesh_terms: D000006:Abdomen, Acute / Q000000981:diagnostic imaging* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004386:Duodenum / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000000981:diagnostic imaging* / Q000601:surgery; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods* / Q000592:standards; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods / Q000592:standards; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013270:Stomach / Q000000981:diagnostic imaging* / Q000601:surgery; D013275:Stomach Rupture / Q000000981:diagnostic imaging* / Q000601:surgery; D013997:Time Factors; D055815:Young Adult