Ulus Travma Acil Cerrahi Derg. 2013; 19(1): 33-40 | DOI: 10.5505/tjtes.2013.44538

Gastrointestinal Kanal Perforasyonlarýnda Perforasyon Bulgularýnýn ve Yerinin Saptanmasýnda Batýn Bilgisayarlý Tomografinin Rolü

Mehtap Ilgar, Muzaffer Elmali, Mehmet Selim Nural
Ondokuz Mayýs Üniversitesi Týp Fakültesi Radyoloji Anabilim Dalý, Samsun

Amaç: Bu çalýþmada gastrointestinal kanal perforasyonlu hastalarda batýn bilgisayarlý tomografinin perforasyon bulgularýný ve perforasyon yerini belirlemedeki rolünü araþtýrdýk.
Gereç ve Yöntem: Temmuz 2007 ve temmuz 2010 tarihleri arasýnda, gastrointestinal kanal perforasyonu olduðu cerrahi olarak kanýtlanmýþ 47 hastanýn ameliyat öncesi batýn BT görüntüleri retrospektif olarak yeniden deðerlendirildi. Her bir hasta için BT de serbest hava, kontrast madde kaçaðý, duvar kalýnlaþmasý, duvar devamsýzlýðý, apse, flegmon ve serbest sývý varlýðý araþtýrýldý. Belirlenen bu bulgular ýþýðýnda perforasyon yeri tahmin edildi ve cerrahi sonuçlar ile karþýlaþtýrýldý.
Bulgular: Batýn BT bulgularýna göre; gastroduodenal perforasyonu olan hastalarýn %85,7’sinde, ince barsak perforasyonu olanlarýn %85,7’sinde, kalýn barsak perforasyonu olanlarýn %69,2’sinde, rektum perforasyonu olanlarýn %100’ünde, apendiks perforasyonu olanlarýn %90,9’unda, tüm hastalarýn ise %82,9’unda perforasyon yeri doðru olarak belirlendi. Gastrointestinal kanal perforasyonunda BT’ de en sýk rastlanan bulgu % 89.4 oraný ile batýnda serbest sývý idi. Diðer bulgularýn rastlanma oranlarý ise sýrasýyla þöyleydi; serbest hava: %76.6, segmental duvar kalýnlaþmasý: %48.9, duvar devamsýzlýðý: %25.5, apse: %12.8, flegmon: %10.6. Oral kontrast kullanýlan 30 hastanýn 7 sinde (%23.3) ekstraluminal kontrast kaçaðý saptandý.
Sonuç: BT gastrointestinal kanal perforasyon bulgularýný ve perforasyon yerini belirlemede oldukça etkilidir.

Anahtar Kelimeler: Tomografi, Spiral Tomografi, Ýntestinal Perforasyon

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The Role of Abdominal CT in Determining Perforation Findings and Site in Patients with Gastrointestinal Tract Perforation.

Mehtap Ilgar, Muzaffer Elmali, Mehmet Selim Nural
Department Of Radiology, Ondokuz Mayis University Medical Faculty, Samsun

Background: In this study, we investigated the role of abdominal CT in determining perforation findings and site in patients with gastrointestinal tract perforation.
Methods: Preoperative abdominal CT scans of 47 patients who had surgically proven gastrointestinal tract perforation between July 2007 and July 2010 were reviewed, retrospectively. The presence of free air, leakage of contrast material, wall thickness, wall discontinuity, abscess, free fluid and phlegm on were investigated for each patient. The results were compared with the surgical outcomes.
Results: Perforation sites were determined correctly in 85.7% of the patients with gastro duodenal perforation, 85.7% of the patients with small bowel perforation, 69.2% of the patients with large bowel perforation, 100% of the patients with rectum perforation, 90.9% of the patients with appendix perforation, and 82.9% of all the patients according to the abdominal CT findings. The most common CT finding in gastrointestinal tract perforation was free fluid with a rate of 89.4%. The rate of other findings were as follows respectively: free air 76.6 %, segmental wall thickening 48.9%, wall discontinuity 25.5%, abcess 12.8%, phlegmon 10.6%. Of 30 patients who received oral contrast, 7(23.3%) had extraluminal contrast leakage.
Conclusion: CT is very effective in determining gastrointestinal tract perforation findings and site of perforation.

Keywords: Tomography, Spiral Computed Tomography, Intestinal Perforation

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ATIF KOPYALA