GASTROİNTESTİNAL PERFORASYON TANISINDA KULLANILAN GÖRÜNTÜLEME YÖNTEMLERİ VE GÖRÜNTÜLEME BULGULARI

Öz

Amaç: Bu çalışmanın amacı gastrointestinal perforasyon (GIP) tanısı konulan hastalarda kullanılan görüntüleme yöntemlerini ve bu yöntemlerin tanıya katkısını değerlendirmekdir. Yöntemler: Çalışmamızda operasyon sonuçları GIP olarak belirtilen 18 yaş ve üzeri 73 hastanın operasyon öncesi radyolojik tetkikleri retrospektif olarak değerlendirildi. Perforasyon bölgeleri mide-duedenum birinci kesimi, duedenum ikinci kesimi başlangıcından itibaren ince barsak, kolorektal ve apendiks olarak 4 gruba ayrıldı. Özefagus perforasyonları ayrı bir grup olarak düşünülüp çalışma dışı bırakıldı. Bulgular: Hastaların 52 (%71.2) si erkekdi. Yaşları 18 ile 87 arasında olup ortalama yaşları 45.1±18.2 bulundu. 40(%54.8) hastada apendiks perforasyonu, 25(%34.2) hastada mideduedenum perforasyonu vardı. 56 (%76.7) hastaya bilgisayarlı tomografi (CT), 55 (%75.3) hastaya ultrasonografi (USG) ve 48(%65.8) hastaya radyografi (RG) tetkiki yapılmışdı. Hastaların RG leri subdiafragmatik serbest hava varlığı açısından değerlendirildiğinde apendiks dışı perforasyonu olan hastaların %50 sinde subdiyafragmatik serbest hava görüldü. Apendiks perforasyonu olan hastaların USG lerinde en sık tanımlanan bulgular çap artışı ve mezenterik yağlı dokuda heterojenite iken diğer perforasyonlarda en sık USG bulgusu serbest sıvıydı. CT ile apendiks dışı perforasyonu olan hastaların %83.9’unda perforasyon yeri doğru olarak belirlendi. Sonuç: Çalışmamızda GIP tanısı konulurken en fazla tercih edilen ve tanısal değeri en yüksek olan görüntüleme modalitesinin CT olduğunu saptadık. Ek olarak CT perforasyon yerini belirlemede de faydalıydı.

Anahtar Kelimeler

• Gastrointestinal sistem
• perforasyon
• görüntüleme

Imaging Methods Used in The Diagnosis of Gastrointestinal Perforation and Imaging Findings

Abstract

Purpose: To evaluate the imaging methods used in patients diagnosed with gastrointestinal perforation (GIP) and the contribution of these methods to the diagnosis. Methods: Preoperative radiological examinations of 73 patients 18 years old or older whose surgical results indicated GIP were retrospectively evaluated. The perforation sites were divided into 4 groups, namely the first segment of the gastroduodenum, part of the small intestine beginning with the second segment of the duodenum, the colorectum, and the appendix. Esophageal perforations were considered as a separate group and excluded from the study. Findings: Fifty-two (71.2%) of the patients were male. The mean age of the patients was 45.1±18.2 years with a range of 18-87 years. Forty (54.8%) patients had perforations of the appendix and 25 (34.2%) patients had perforations of the gastroduodenum. Computed tomography (CT) was performed in 56 (76.7%) of the patients, ultrasonography (USG) in 55 (75.3%), and radiography (RG) in 48 (65.8%). The evaluation of RG images of the patients for the presence of subdiaphragmatic free air showed that 50% of the patients with non-appendix perforations had subdiaphragmatic free air. The most common findings in the USG results of the patients with appendix perforations were an increase in the diameter and heterogeneity of mesenteric fatty tissue, while the most common USG finding in the patients with the other perforations was free fluid. The site of perforation was accurately determined in 83.9% of the patients diagnosed with non-appendix perforations by CT. Conclusion: CT is the most preferred imaging modality and has the most diagnostic value in the diagnosis of GIP. It is also useful in determining the perforation site.

Keywords

• Gastrointestinal tract
• perforation
• imaging

Kaynakça

1. 1. Romano S, Somma C, Sciuto A, et al. MDCT Findings in Gastrointestinal Perforations and the Predictive Value according to the Site of Perforation. Tomography. 2022; 8: 667-687.
2. 2. Siu WT, Chau CH, Law BK, et al. Routine use of laparoscopic repair for perforated peptic ulcer. Br J Surg 2004;91:481-4.
3. 3. Hainaux B, Agneessens E, Bertinotti R, De Maertelaer V, Rubesova E, Capelluto E, et al. Accuracy of MDCT in predicting site of gastrointestinal tract perforation. AJR Am J Roentgenol 2006;187:1179-83.
4. 4. Singh JP, Steward MJ, Booth TC, et al. Evolution of imaging for abdominal perforation. Ann R Coll Surg Engl 2010; 92: 182–188.
5. 5. Faggian A, Berritto D, Iacobellis F, et al. Imaging Patients With Alimentary Tract Perforation: Literature Review. Semin Ultrasound, CT MR. 2016; 37(1): 66-69.
6. 6. Kuzmich S, Burke CJ, Harvey CJ, Kuzmich T, Fascia DTM. Sonography of Small Bowel Perforation. AJR. 2013; 201: 283–291.
7. 7. Coppolino FF, Gatta G, Di Grezia G, et al. Gastrointestinal perforation: ultrasonographic diagnosis. Critical Ultrasound Journal. 2013; 5(Suppl 1): S4
8. 8. Furukawa A, Sakoda M, Yamasaki M, et al. Gastrointestinal tract perforation: CT diagnosis of presence, site, and cause. Abdom Imaging. 2005; 30: 524–534.

9. 9. Ilgar M, Elmalı M, Nural MS. The role of abdominal computed tomography in determining perforation findings and site in patients with gastrointestinal tract perforation. Turkish Journal of Trauma & Emergency Surgery. 2013; 19(1): 33-40.
10. 10. Maniatis V, Chryssikopoulos H, Roussakis A, et al. Perforation of the alimentary tract: evaluation with computed tomography. Abdom Imaging 2000; 25: 373–379.
11. 11. Pouli S, Kozana A, Papakitsou I, et al. Gastrointestinal perforation: clinical and MDCT clues for identification of aetiology. Insights into Imaging. 2020; 11: 31.
12. 12. Shin D, Rahimi H, Haroon S, et al. Imaging of Gastrointestinal Tract Perforation. Radiol Clin N Am 2020; 58: 19–44.
13. 13. Nouri D, Soleimanian N, Ataei F, et al. Effects of sex, age, size and location of perforation on the sensitivity of erect chest X-ray for gastroduodenal perforation. Radiography. 2021; 27 (4): 1158-1161.
14. 14. Shaffer HA (1992) Perforation and obstruction of the gastrointestinal tract. Assessment by conventional radiology. Radiol Clin North Am 30:405–426.
15. 15. Şahin T. Contribution of ethical approach and effective communication to the correct diagnosis of acute appendicitis – a single center experience from a pragmatic perspective. Eur Rev Med Pharmacol Sci 2022; 26 (11): 3911-3918.
16. 16. Rawolle T, Reismann M, Minderjahn M, et al. Sonographic differentiation of complicated from uncomplicated appendicitis. BJR. 2019; 92(1099): 20190102.
17. 17. Leeuwenburgh MMN, Wiezer MJ, Wiarda BM, et al. Accuracy of MRI compared with ultrasound imaging and selective use of CT to discriminate simple from perforated appendicitis. BJS. 2014; 101(1): 147-155.
18. 18. Park JM, Yoon YH, Horeczko T, et al. Changes of Clinical Practice in Gastrointestinal Perforation with the Increasing Use of Computed Tomography. Journal of Trauma and Injury. 2017; 30(2): 25-32.
19. 19. Imuta M, Awai K, Nakayama Y, et al. Multidetector CT findings suggesting a perforation site in the gastrointestinal tract: analysis in surgically confirmed 155 patients. Radiat Med 2007;25:113-118.
20. 20. Rodriguez LC, de Gracia MM, Galan NS, et al. Use of multidetector computed tomography for locating the site of gastrointestinal tract perforations. Cir Esp. 2013; 91(5): 316-323.
21. 21. Lee D, Park M, Shin BS, Jeon GS. Multidetector CT diagnosis of non-traumatic gastroduodenal perforation. Journal of Medical Imaging and Radiation Oncology. 2016; 60: 182-186.
22. 22. Kim HY, Park JH, Lee YJ, et al. Systematic Review and Meta-Analysis of CT Features for Differentiating Complicated and Uncomplicated Appendicitis. Radiology. 2018;287(1):104-115.
23. 23. Avanesov M, Wiese NJ, Karul M, et al. Diagnostic prediction of complicated appendicitis by combined clinical and radiological appendicitis severity index (APSI). Eur Radiol. 2018;28(9):3601-3610.