Early radiological diagnostics of gastrointestinal perforation

Background. The goal is to present the possibilities of radiological procedures and the early detection of gastrointestinal perforation as a common cause of acute abdomen. Methods. During one year period, in emergency conditions, we evaluated 20 patients with gastrointestinal perforation. Native x-ray, ultrasound and CT of abdomen were performed on all patients, and on some of them with per os administration of 250 ml contrast, ultrasound was performed with 3, 5 MHz probe on a Siemens machine. CT scans were done on the multi row detector computed tomography (MTDC) »Volume Zoom«, Siemens with four rows of detectors and 2.5 mm width. All patients were admitted with clinical symptoms of acute abdomen. Results. A group of 20 evaluated patients consisted of 8 (40%) women and 12 (60%) men of 41 as average age. The youngest patient was 14, and the eldest 67 years old. 7 (35%) had stomach perforation and 10 (50%) duodenum perforation. There was also a traumatic colon transversal perforation in one case, in the second was stitches rupture after the stomach operation and the third was the sigma perforation caused by the malign process. Out of all above mentioned cases, in 18 (90%) cases perforation occurred spontaneously and in 2 (10%) cases artificialy. Native x-ray of abdomen showed free air in the abdominal cavity in 16 (80%) cases. Ultrasound gave positive results on free liquid in 18 (90%) and CT scan revealed both free liquid and air in 20 (100%) cases. Conclusions. The significance of an early and reliable discovery of gastrointestinal perforation is very important, because it usually requires the surgical intervention. Along with anamnesis, native x-ray of abdomen was and is traditionally the first procedure, especially in the detection of free air. With the development of digital techniques such as ultrasound and CT, we have a new diagnostic procedure at our disposal, especially in detecting free liquid and air as early signs of digestive perforation. According to our researches, ultrasound proves to be very useful in examining free liquid, while CT was more sensitive to the combination of liquid and minimal amount of free air, which was undetectable to ultrasound and x-ray.