Imaging of gastrointestinal tract perforation in the elderly patient

Gastrointestinal perforation is a medical emergency that requires immediate medical care. Chances of recovery improve with an early diagnosis and treatment.Gastrointestinal perforation occurs when a hole forms all the way through the stomach, small intestine, and large intestine. It might be caused by a number of different diseases, including foreign bodies, colon cancer, diverticulitis, ischaemia, Degos’ syndrome, and inflammatory bowel disease. The contents of these organs are then able to spill over into the abdominal cavity. Intestinal perforation is an emergency medical situation presented as an acute abdomen, and it is only rarely diagnosed clinically. CT is often the initial modality used to assess patients with acute abdomen; the radiologist may be the first to suggest such a diagnosis. Computed tomography allows to identify the site of gastrointestinal perforations and to determine the most predictive signs in this diagnosis. Several studies have demonstrated that computed tomography (CT) is the best technique for detecting free intraperitoneal air and for the diagnosis of GI perforation. The overall accuracy in diagnosing the site of the perforation is 80%.CT is the most reliable imaging modality for detecting even small amounts of free air. Extraluminal oral contrast is a specific sign of gastrointestinal tract perforations (more clearly seen on a lung window setting). Additional CT signs, which may also indicate the site of the perforation, include discontinuity of the bowel wall on an enhanced scan and focal thickening of the bowel wall adjacent to extraluminal gas bubbles, streaky density within the mesentery ‘dirty fat’ sign, and focal collection of extraluminal faecal matter ‘dirty mass’ were considered indirect finding of perforation.