Acute gastroduodenal peptic ulcer perforation: contrast-enhanced and thin-section spiral CT findings in 10 patients

Background: To describe contrast-enhanced and thin-section spiral computed tomography (SCT) findings in patients with acute gastroduodenal peptic ulcer perforation (GPUP). Methods: Abdominal SCTs in 10 patients with confirmed acute perforated gastroduodenal (GD) peptic ulcer were retrospectively reviewed. Patients were 24–76 years old (mean = 44 years); seven were men and three were women. Diagnosis of GD peptic ulcer was done by endoscopy or surgery. Eleven ulcers were identified, two in the antrum and nine in the duodenum. SCTs were obtained after intravenous contrast medium without oral administration. Slice thickness was 3 or 5 mm. CT findings were correlated with surgical (n= 5) or endoscopic (n= 5) findings. Results: Eight patients had pneumoperitoneum. All patients had evidence of GD wall thickening and enhancement and inflammatory changes in perigastroduodenal soft tissues or organs. Discontinuity in the GD wall and/or tiny air bubbles in close proximity indicated the site of perforation in eight cases. Conclusions: Abdominal SCT enables diagnosis and location of GPUP. A well-controlled prospective study with a larger group is needed to determine the sensitivity and specificity of this technique. Received: 8 June 1998/Accepted: 29 July 1998