CT Features for the Detection of Bowel Perforation Sites by Blunt Abdominal Trauma

PURPOSE: We evaluated the CT criteria useful for the diagnosis of the site of bowel perforation in patients with this or mesenteric injury caused by blunt abdominal trauma. MATERIALS AND METHODS: CT findings of 26patients with blunt abdominal trauma were retrospectively analyzed by two observers who were unaware of operative findings, and the results of their analysis were compared with those findings. Twenty cases of bowel perforation found at the jejunum (8), ileum (9), and colon (3), and six cases of mesenteric injuries were confirmed byoperation. We evaluated CT findings of 1) segmental bowel wall thickening, b) focal mesenteric fat infiltration, c) loculated fluid collection and d) extraluminal air adjacent to the bowel, and in addition analyzed the locations of ascites and free air, and the associated injuries of solid organs. RESULTS: The most common finding at the site of bowel perforation was segmental bowel wall thickening (17 cases), followed by focal mesenteric fatinfiltration (12 cases), loculated fluid (12 cases) and extraluminal air ajacent to the bowel (9 cases). Segmental bowel wall thickening was present at 34 sites, and the perforations were confirmed at 17 of these(50%). Focalmesenteric fat infiltration was present at 19 sites ; the perforations were proven at 12(63%). Loculated fluid collections were confirmed at 12/20 sites(60%), and extraluminal air adjacent to the bowel at 9/12(75%). Thepositive predictive value of criteria a, b, d, c) was 100%, and the positive predictive values of a, b, c) and a,d) were 60 and 67%, respectively. We observed ascites in 16 cases and intraperitoneal free air in 8 cases, the locations of ascites and free air did not, however, significantly correlate with the perforation sites. CONCLUSION: Extraluminal air adjacent to the bowel was the most specific criterion, and segmental bowel wall thickening wasthe most sensitive criterion. of all criteria, the finding 'a, b, c, d' most accurately predicted the site ofbowel perforation.

Evaluation of the Safety of Iatrogenic Intestinal Perforation during Placement of Percutaneous Drainage Catheter in Rabbit

PURPOSE: To evaluate the safety of transgression of the bowel during intraperitoneal percutaneous catheter placement in an animal model. MATERIALS AND METHODS: Eight 8-F straight catheters were percutaneously insertedinto the small and large bowel of eight rabbits. In four animals, the catheters were left in place until autopsy, whereas in the remaining four, the catheters were withdrawn five days after insertion. Autopsy was performed inall animals ten days after catheter placement, and gross and microscopic examination was carried out. RESULTS: Transgressing the bowel during intraperitoneal percutaneous catheter placement did not contribute to any clinically significant complications. At autopsy, there was no bowel leakage, peritonitis, or abscess, although peritoneal adhesions were found around the catheter tract. CONCLUSION: Although further study is warranted, ourstudy with an animal model indicated that transgression of the intestine during percutaneous placement of an intraabdominal catheter did not produce significant complications.

Spontaneous Perforation of Small Bowel Lymphoma Causing Massive Pneumoperitoneum: A case Report

The gastrointestinal lymphoma is a well known entity for bleeding or perforation during treatment, but spontaneous perforation is not common. We report the CT findings of an unusual case of small bowel lymphoma which presented with massive pneumoperitoneum following spontaneous perforation.