Small bowel perforations: Imaging findings

Abstract

Perforations of the small bowel could represent a critical challenge in diagnosis, either in emergency or elective conditions. Small bowel perforations could have different causes, such asblunt or penetrating trauma, iatrogenic injuries, mechanical obstruction, inflammatory complications, tumors, and postoperative anastomotic leaks. Imaging methods are indicated for an effective diagnosis. Conventional radiograph could attest the presence of free peritoneal air, whereas sonographic examination could reveal the evidence of free peritoneal fluid. CT examination is usually required in patients with acute abdominal conditions, and the use of intravenous contrast medium is indicated especially when clinical suspicion is not well defined and to allow a correct complete diagnosis. MDCT as a cross-sectional imaging method could be considered a good tool to perform a correct diagnosis in visualizing the amount, site, and distribution of the free peritoneal air, as well as the feature of the bowel wall, the bowel distension or collapse, and the presence of bowel wall discontinuity. Additional abdominal findings could also be of help in making suggestive diagnosis of small bowel perforation.