Value of computed tomography in the diagnosis of the cause of nontraumatic gastrointestinal tract perforation.

Objective: To identify computed tomographic features with a high predictive value to differentiate gastroduodenal ulcer perforations from other causes of perforations in patients with a non-traumatic-free pneumoperitoneum.

Materials And Methods: Computed tomographic scans of 81 patients with a non-traumatic-free pneumoperitoneum were reviewed for direct visualization of the perforation site and indirect findings of the perforation, including the presence, amount, and localization of air and ascites in the peritoneal cavity, mural thickness of the gastrointestinal tract, perigastrointestinal fat stranding, intestinal ischemia, fecal peritonitis, abscess, and portomesenteric venous gas.

Results: The perforation site was directly visualized in 16 (41%) of 39 patients with gastroduodenal ulcer perforation and in 5 (12%) of 42 patients with other causes of perforation.