Takayuki Kondo, Takashi Oishi, Yuri Miyoshi, Yuichi Nishihara, Yoshiki Kawaguchi, Jo Tokuyama, Koji Osumi, Hidejiro Urakami, Shiko Seki, Tetsu Matsui, Yo Isobe, Sumio Matsumoto. Tokyo Medical Center
INTRODUCTION: Gastrointestinal (GI) perforation is one of acute abdomen and frequently results in fatal septic shock and multiple organ failure. As the choice of treatment (conservative or operative) depends on the site of perforation, the accurate diagnosis is absolutely important. The combination of three findings (concentration of extraluminal air bubbles, segmental bowel wall thickening, and focal defect of the bowel wall) on abdominal computed tomography are useful for predicting the precise location of perforation. The objectives of this study is to evaluate the sensitivities of these findings and the effect of computed tomography (CT) attenuation values of ascites on GI perforation site prediction.
METHODS: The CT attenuation values of the ascites from 53 patients with GI perforations were assessed three findings and measured the CT attenuation values of ascites. The effect of the CT attenuation values of the ascites on perforation site prediction and postoperative complications was evaluated.
RESULTS: Between April 2012 and March 2016, patients with gastrointestinal perforation were included. Of these, 53 could be preoperatively diagnosed. The sensitivity by the site of perforation is 88% in upper gastrointestinal tract, 83% in small intestine and 90% in large intestine, suggesting that three CT findings are helpful in the identification of the site of perforation. Of 21 patients with colorectal perforations, the CT attenuation values of ascites were significantly higher than those in patients with perforations at other sites [23.2 Hounsfield units (HU) vs 15.1 HU, respectively, P = 0.0002]. The prediction rate of colorectal perforation using attenuation values as an auxiliary diagnosis improved by 9.5% compared to that of CT findings alone (100.0% vs 90.5%).
From the data obtained by the 2D method, an ROC curve was drawn. The area under the curve was calculated as 0.82, which indicated strong abilities to predict perforation sites. A cut-off value of a perforation site was estimated at 17.3 HU. Using this cut-off value, the sensitivity of colorectal perforation prediction was 76.7% (23/30), whereas the specificity was 91.3% (21/23).
CONCLUSION: The combination of three CT findings is useful for predicting the precise location of perforation. The CT attenuation values of ascites could facilitate the prediction of perforation sites in GI perforations, particularly in cases in which the perforation sites are difficult to predict by CT findings alone.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79537
Program Number: P070
Presentation Session: Poster (Non CME)
Presentation Type: Poster
