The emergency room diagnosis of gastrointestinal tract perforation: the role of CT

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• 作者：Samuel Borofsky ; Myles Taffel ; Nadia Khati ; Robert Zeman…
• 关键词：Gastrointestinal tract ; Perforation ; Free air ; Pneumoperitoneum
• 刊名：Emergency Radiology
• 出版年：2015
• 出版时间：June 2015
• 年：2015
• 卷：22
• 期：3
• 页码：315-327
• 全文大小：7,849 KB
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• 作者单位：Samuel Borofsky (1)
  Myles Taffel (1)
  Nadia Khati (1)
  Robert Zeman (1)
  Michael Hill (1)
  
  1. Department of Radiology, The George Washington University Hospital, 900 23rd Street NW, Washington, DC, 20037, USA
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Imaging and Radiology
  Emergency Medicine
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1438-1435

文摘

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.