title: The emergency room diagnosis of gastrointestinal tract perforation: the role of CT.
abstract: Computed tomography (CT) plays an important role in the evaluation of patients presenting to the emergency department with a suspected spontaneous gastrointestinal tract (GIT) perforation. Prospective identification of the site of perforation helps the emergency department physician plan the appropriate treatment in a potentially unstable patient. The purpose of this pictorial essay is to review the CT approach a radiologist should take when evaluating the patient with suspected perforation in the emergent setting. A series of patients presenting to the emergency department with surgically proven GIT perforations were retrospectively reviewed, and key images were obtained. For the purposes of this review, the anatomy of the abdominal cavity in relation to sites of GIT perforation will be discussed. CT findings of perforation will be described, including free intraperitoneal/extraperitoneal air, bowel wall discontinuity, and localized inflammatory changes. The use of a bone window setting to increase the free air conspicuity will be emphasized. The mimics of pneumoperitoneum will be demonstrated, including pneumothorax, pneumomediastinum, and venous air. Using a systematic approach, CT can precisely determine the presence and site of a gastrointestinal perforation in a majority of patients. This greatly assists the surgeon in planning the correct surgical approach.
authors.affiliation: Department of Radiology, The George Washington University Hospital, 900 23rd Street NW, Washington, DC, 20037, USA, sborofsky@gmail.com.
authors.forename: Samuel
authors.initials: S
authors.lastname: Borofsky
authors.forename: Myles
authors.initials: M
authors.lastname: Taffel
authors.forename: Nadia
authors.initials: N
authors.lastname: Khati
authors.forename: Robert
authors.initials: R
authors.lastname: Zeman
authors.forename: Michael
authors.initials: M
authors.lastname: Hill
mesh_terms: D003287:Contrast Media; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D006801:Humans; D007416:Intestinal Perforation / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media