Multidetector CT diagnosis of non-traumatic gastroduodenal perforation

• Published in: Journal of medical imaging and radiation oncology Vol. 60; no. 2; pp. 182 - 186
• Main Authors: Lee, Dabee, Park, Mi-hyun, Shin, Byung Seok, Jeon, Gyeong Sik
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01.04.2016; Wiley Subscription Services, Inc
• Subjects: Adult; Aged; Aged, 80 and over; Causality; Comorbidity; Defects; Female; Humans; intestines; Localization; Male; Middle Aged; multidetector computed tomography; Multidetector Computed Tomography - statistics & numerical data; Patients; peptic ulcer; Peptic Ulcer - diagnostic imaging; Peptic Ulcer - epidemiology; Peptic Ulcer Perforation - diagnostic imaging; Peptic Ulcer Perforation - epidemiology; perforation; Prevalence; Reproducibility of Results; Republic of Korea - epidemiology; Risk Factors; Sensitivity and Specificity; Ulcers; perforation; intestines; peptic ulcer; multidetector computed tomography
• ISSN: 1754-9477; 1754-9485
• DOI: 10.1111/1754-9485.12408

Introduction To identify reliable CT features and assess the diagnostic performance of 64‐multidetector CT (MDCT) in diagnosing non‐traumatic gastroduodenal perforation (GDP). Methods We retrospectively reviewed 136 CT scans of patients with surgically proven non‐traumatic gastrointestinal perforation during 7 years. 92 patients had GDP and 44 patients had other sites of perforation. CT features of perforation were evaluated and the sensitivity, specificity and likelihood ratios of each CT feature were estimated. Results The cause of GDP was peptic ulcer in 90 patients, gastric cancer in one patient, and foreign body of duodenal diverticulum in one patient. Extraluminal gas (97%) was most common CT feature of GDP, following by fluid or fat strand along gastroduodenum (89%), ascites (89%), wall defect and/or ulcer (84%), and wall thickening (72%). Of CT features, wall defect and/or ulcer showed the best positive likelihood ratios for GDP (36.83). Wall thickening also showed high positive likelihood ratios (10.52). Combined, these CT features showed 95% sensitivity and 93% specificity for localization of perforation site of GDP. Conclusion MDCT is useful in diagnosis of presence and site of GDP. Wall defect and/or ulcer and wall thickening have a high positive predictive value for localization of perforation site.