Duodenal perforation: role of multi detector computed tomography (MDCT)

Pokhraj Prakashchandra Suthar, Gaurav Pandey, Jigar J. Patel, Rajkumar Prakashbhai Doshi

Abstract


Perforation of peptic ulcers, more specifically; ulcers of the first part of the duodenum carry mortality up to 11 %, with a higher mortality seen in patients over the age of 50 years. Main symptoms are acute onset abdominal pain and vomiting. Guarding & rigidity is present on examination. Conventional X-ray abdomen standing is the first investigation, which shows free gas under diaphragm. MDCT scan is required for identifying the presence, site and cause of gastrointestinal tract perforation. Early diagnosis and treatment is mandatory as it is a grave emergency condition.


Keywords


Duodenal perforation, X-ray, MDCT

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References


Ramakrishnan K, Salinas RC. Peptic ulcer disease. Am Fam Physician. 2007;76:1005-12.

Martinez JP, Mattu A. Abdominal pain in the elderly. Emerg Med Clin North Am. 2006;24:371-88.

Newton E, Mandavia S. Surgical complications of selected gastrointestinal emergencies: pitfalls in management of the acute abdomen. Emerg Med Clin North Am. 2003;21:873-907, viii.

Pieracci FM, Barie PS. Management of severe sepsis of abdominal origin. Scand J Surg. 2007;96:184-96.

Baker SR. Plain films and cross-sectional imaging for acute abdominal pain: unresolved issues. Semin Ultrasound CT MR. 1999;20:142-7.

Malfertheiner P, Chan FKL, McColl KEL. Peptic ulcer disease. Lancet. 2009;374:1449-61.

Lau JY, Sung J, Hill C, Henderson C, Howden CW, Metz DC. Systematic review of the epidemiology of complicated peptic ulcer disease: incidence, recurrence, risk factors and mortality. Digestion. 2011;84:102-13.

Grassi R, Romano S, Pinto A, Romano L. Gastro-duodenal perforation: conventional plain film, US and CT findings in 166 consecutive patients. Eur J Radiol. 2004;50:30-6.

Bruner DI, Gustafson C. Respiratory distress and chest pain: a perforated peptic ulcer with an unusual presentation. Intern J Emerg Med. 2011;4:34-8.

Canoy DS, Hart AR, Todd CJ. Epidemiology of duodenal ulcer perforation: a study of hospital admission in Norfolk, United Kingdom. Dig Liv Dis. 2002;34:322-7.

Shen Y, Ong P, Gandhi N, Degirolamo A. Subphrenic abscess from perforated duodenal ulcer. Cleveland Clin J Med. 2011;78:6.

Oguro S, Funabiki T, Hosoda K, Inoue Y, Yamane T, Sato M, et al. 64-slice multi-detector computed tomography evaluation of gastrointestinal tract perforation site: detectability of direct findings in upper and lower GI tract. Eur Radiol. 2010;20:1396-403.

Yeung K-W, Chang M-S, Hsiao C-P, Huang J-F. CT evaluation of gastrointestinal tract perforation. J Clin Imaging. 2004;28:329-33.