Table 1 Presenting symptoms, imaging and clinical considerations in relation to site and causes of upper GIT perforation

Oesophagus

Severe distress, sudden-onset pain, fever, dysphagia, dyspnea, hoarseness, dysphonia, tachycardia, crepitus

Mural defect, pneumomediastinum, free mediastinal contrast, free mediastinal fluid, mural gas, subcutaneous emphysema, wall thickening, mediastinal or cervical fat stranding, pleural effusion

Iatrogenic

History of instrumentation

Spontaneous

Hyperemesis

Foreign body

Visible food bolus, impacted foreign body

Investigate for underlying stricture

Trauma

History of penetrating injury

Tumour

Massive wall thickening, oesophago-respiratory fistula

History of radiotherapy, instrumentation, stent placement

Gastroduodenal

Acute abdominal pain, guarding, rebound tenderness, non-specific pain (in RP)

Supramesocolic pneumoperitoneum, gas in ligamentum teres, gas in falciform ligament, gas in lesser sac, oral contrast leakage, mural defect, gas in anterior pararenal space (in RP)

PUD

Mucosal hyperenhancement

Helicobacter pylorii infection

Luminal outpouching

Drugs, stress, tobacco, alcohol abuse

Trauma

Gas in wound track

History of trauma

Solid organ injuries

Iatrogenic

Gas outlining gastric band, subphrenic abscess

History of instrumentation or history of gastric banding

Intraluminal band/sutures

Tumour

Irregular wall thickening

Mucosal/submucosal enhancement

Perivisceral soft-tissue extension

Peritoneal/nodal spread

Metastatic disease

Foreign body

Radiopaque structure by a fistula, opacity by a liver abscess

Individuals with reduced palate sensitivity, alcohol abuse, children, elderly, mentally handicapped