Perforation of the alimentary tract: evaluation with computed tomography

Background: To assess the value of computed tomography (CT) in the diagnosi s of perforation of the alimentary tract (AT). Methods: During a 4-year period 76 patients with proven AT perforation unde rwent CT within 1 week before surgery or endoscopy. We retrospectively revi ewed these CT scans to determine the signs of AT perforation. There were 41 men and 35 women (28-90 years old). Our goal was to establish the diagnosi s of AT perforation and, if this was possible, to identify the site and cau se of the AT wall rupture. The CT diagnosis of perforation was based on (a) direct findings of extraluminar air or gastrografin and (b) indirect findi ngs of an abscess or an inflammatory mass surrounding an enterolith in the region of appendix or a bowel wall-related phlegmon or abscess with fluid i n the mesentery or surrounding radiopaque foreign body. Results: There were 65 true-positive and 11 false-negative cases. Levels of perforation were the esophagus (two), stomach (five), duodenum (12), small bowel (15), appendix (six), and colon (36). Causes were peptic ulcer (11), foreign body (five), trauma (seven), iatrogenic (nine), appendicitis (six) , diverticulitis (21), Crohn disease (five), AT carcinoma (eight), and isch emia (four). Level and cause were correctly predicted in 55 and 51 instance s, respectively. The sensitivity was estimated to 85.5%. Conclusion: CT is a valuable method in the diagnosis of AT perforation. The diagnosis can be established rapidly, without patient preparation and with a high sensitivity.