MDCT accurately locates bowel perforation avoiding need for exploratory surgery

Multidetector CT (MDCT) without the use of contrast media can show the precise site of a bowel perforation, avoiding the need for surgeons to do exploratory surgery of the patient's gastrointestinal tract to locate the problem, a new study shows.

In the past, the best way to find a perforation in the bowel was to administer oral or rectal contrast media then watch to see if and where the contrast media leaked from the bowel, said Bernard Hainaux, MD of Centre Hospitalier Universitaire St.-Pierre in Brussels, Belgium. Dr. Hainaux was lead author of the study. If there was a leak, then that was assumed to be the site of the perforation, however, this method was not very sensitive , he said. In addition, it is often difficult to administer oral or rectal contrast media to a patient with acute abdominal pain or with penetrating injuries, Dr. Hainaux said.

The study found that MDCT without contrast media could accurately show the site of bowel perforation in 73 of 85 patients, Dr. Hainaux said. Radiologists should look for three things on the MDCT image – gas bubbles near the bowel wall, a defect in the bowel wall and thickening of the bowel wall—they all point to the location of the bowel perforation, he added.

It is very beneficial for surgeons to know in advance where the bowel is perforated, Dr. Hainaux said. "MDCT allows us to quickly image the patient, then reformat the images so we can look at them from many different angles, making this technique particularly suitable for the assessment of abdominal abnormalities," he said.

The study appeared in a recent issue of the American Journal of Roentgenology, published by the American Roentgen Ray Society.