Diagnostic accuracy of computed tomography in localizing gastrointestinal perforations: Focusing on gastric and duodenal defects

Purpose

To provide a detailed assessment of the accuracy and reproducibility of Computed Tomography (CT) in localizing gastrointestinal perforations, with a focus on distinguishing gastric and duodenal defects.

Methods

This single-center retrospective study evaluated subjects with surgically confirmed gastrointestinal perforation who underwent preoperative contrast-enhanced abdominopelvic CT. Two subspecialized radiologists reviewed each CT independently to identify the perforation site, to differentiate gastroduodenal from perforations in other locations, and to differentiate between gastric and duodenal perforation, using defined CT signs such as gas inclusions, pneumoperitoneum, and thickened gastrointestinal walls. For gastroduodenal perforations, accuracy of Minimum Intensity Projection (MinIP) reconstructions was also assessed. Inter-reader agreement was calculated using Cohen’s kappa statistics.

Results

156 patients (M/F: 89/67; median age: 62 years) met inclusion criteria. CT accuracy in distinguishing all perforation sites was 73.1 % for Reviewer 1 and 67.9 % for Reviewer 2 (k = 0.72). When differentiating gastroduodenal from other perforations, accuracy increased to 94.9 % and 88.5 % (k = 0.86). Among gastroduodenal perforations (n = 56; 35.9 %), Reviewer 1 correctly differentiated gastric from duodenal perforation in 79.6 % of cases, and Reviewer 2 in 64.8 %. MinIP imaging increased accuracy to 87 % and 77.8 %, though not significantly (p = 0.47 and p = 0.21).

Conclusion

CT demonstrates high accuracy and reproducibility in localizing gastrointestinal perforations, particularly in differentiating gastric from duodenal defects– a critical distinction for surgical decision making. MinIP reconstructions may be useful as a novel diagnostic adjunct in this context. CT signs such as fluid, fat stranding, and wall thickening were seen in most perforations, though none correlated significantly with correct perforation localization.