Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2015; 21(5): 1573-1579
Published online Feb 7, 2015. doi: 10.3748/wjg.v21.i5.1573
Computed tomography attenuation values of ascites are helpful to predict perforation site
Ryo Seishima, Koji Okabayashi, Hirotoshi Hasegawa, Masashi Tsuruta, Hiroki Hoshino, Toru Yamada, Yuko Kitagawa
Ryo Seishima, Koji Okabayashi, Hirotoshi Hasegawa, Masashi Tsuruta, Hiroki Hoshino, Toru Yamada, Yuko Kitagawa, Department of Surgery, Keio University School of Medicine, Tokyo 1608582, Japan
Author contributions: Okabayashi K, Hasegawa H and Kitagawa Y designed the research; Seishima R, Tsuruta M, Hoshino H and Yamada T performed the research; Seishima R and Okabayashi K analyzed the data; Seishima R and Okabayashi K wrote the paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Koji Okabayashi, MD, Department of Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo 1608582, Japan. okabayashikoji@gmail.com
Telephone: +81-3-33531211 Fax: +81-3-33534707
Received: July 9, 2014
Peer-review started: July 9, 2014
First decision: August 6, 2014
Revised: August 27, 2014
Accepted: October 15, 2014
Article in press: October 15, 2014
Published online: February 7, 2015
Processing time: 215 Days and 8.3 Hours
Abstract

AIM: To evaluate the effect of computed tomography (CT) attenuation values of ascites on gastrointestinal (GI) perforation site prediction.

METHODS: The CT attenuation values of the ascites from 51 patients with GI perforations were measured by volume rendering to calculate the mean values. The effect of the CT attenuation values of the ascites on perforation site prediction and postoperative complications was evaluated.

RESULTS: Of 24 patients with colorectal perforations, the CT attenuation values of ascites were significantly higher than those in patients with perforations at other sites [22.5 Hounsfield units (HU) vs 16.5 HU, respectively, P = 0.006]. Colorectal perforation was significantly associated with postoperative complications (P = 0.038). The prediction rate of colorectal perforation using attenuation values as an auxiliary diagnosis improved by 9.8% compared to that of CT findings alone (92.2% vs 82.4%).

CONCLUSION: The CT attenuation values of ascites could facilitate the prediction of perforation sites and postoperative complications in GI perforations, particularly in cases in which the perforation sites are difficult to predict by CT findings alone.

Keywords: Perforation site prediction; Gastrointestinal perforation; Computed tomography attenuation value; Ascites; Volume rendering method

Core tip: In gastrointestinal (GI) perforations, the prediction of perforation sites is important for surgeons in planning for intensive perioperative care of fatally ill patients. Although multi-detector row computed tomography (CT) continues to gain further acceptance as a diagnostic tool, more precise identification of the perforation site is required in clinical practice. We show that the CT attenuation values of ascites in patients with GI perforations could simply and objectively predict perforation sites and are useful in predicting postoperative complications, particularly in cases in which perforation sites are difficult to predict by CT findings alone.