GI tract perforation – an imaging overview

Perforation (from the Latin perforare – to pierce through) is a serious consequence of gastrointestinal disease compromising gastrointestinal tract (GIT) wall integrity. It can occur anywhere along the GIT and typically manifests as localised or generalised abdominal pain and signs of sepsis.

However, acute abdominal pain can produce ambiguous clinical findings with a multitude of causes beyond perforation, posing a diagnostic dilemma for surgical teams. Prompt operative management is essential to improve outcomes as intra-abdominal sepsis carries a mortality rate of 9.2%. Radiological assessment is an essential component of pre-operative triage and to limit the number of negative laparotomies. Pre-operative imaging can confirm the presence, location and cause of perforation prior to intervention, informing surgical approach. In this article we will provide a diagnostic approach to imaging in GIT perforation in adults.

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