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

From: Gastrointestinal perforation: clinical and MDCT clues for identification of aetiology

Site Presentation CT findings Causes Cause-specific findings Considerations
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
Fever, SIRS, shock*
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
  1. *In late stages. SIRS systemic inflammatory response syndrome, RP retroperitoneal perforation, IP intraperitoneal perforation, RT right