Conventional plain-film radiology, ultrasonography and CT in jejuno-ileal perforation.

PURPOSE: To evaluate conventional radiography, US and CT in identifying jejuno-ileal perforation.

MATERIAL AND METHODS: We retrospectively reviewed the findings of conventional radiography, US and CT in 13 consecutive patients with surgically proven jejuno-ileal perforation.

RESULTS: The site of perforation was the ileum in 10 cases and the jejunum in 3 cases. Free gas was identified in 6 cases (46%) while indirect findings of perforation were found in 7 (54%). The jejunal perforations were diagnosed by indirect findings in all 3 cases. The ileal perforations were diagnosed by direct findings in 6 cases and indirect findings in 4 cases.

CONCLUSION: Conventional radiology did not detect free gas in 7 (54%) of the 13 patients examined. In the absence of free gas, radiology showed indirect signs in all 7 patients, the most common being intraperitoneal free fluid in 5 (71%) of them. Jejunal perforations were more rare than ileal perforations and more difficult to identify by radiology. US was not useful for detecting free gas but it was useful for identifying intraperitoneal free fluid and intestinal paresis. Abdominal CT was useful when performed 6 h after the symptoms began.