Gastrointestinal Imaging

Perforation, gastric

A penetrating ulcer of the stomach may perforate directly into the peritoneal cavity. The perforation usually leads to that gastric contents, including acid, reaching the peritoneum and causing acute peritonitis. The hallmark of diagnosis is pneumoperitoneum. In a characteristic clinical setting this leads to surgical exploration. In elderly patients or when surgery for other reasons is contraindicated further evaluation with iodine contrast medium may reveal the site of the perforation. A tumour of the stomach may also perforate (Fig.1). Penetrating ulcers on the posterior wall of the stomach may be walled off. Pneumoperitoneum may also be confined to the lesser sac only. Treatment is usually surgical.

OE

To view high resolution images,
please register first.

Click  here to register.

Already registered? Enter your e-mail in the window below.
Re-register

Fig.1

Iodine contrast medium study of the stomach. a. Lymphoma of the stomach with bulky infiltration of the antrum (arrow). There is a perforation on the lesser curvature of the distal antrum (thin arrow) and a walled off pneumoperitoneum (arrowhead). b. The same patient examined with CT. There is pneumoperitoneum (arrowhead) and ascites (open arrow). The thickened wall (big arrow) and perforation through the wall can be seen (thin arrow).
Perforation, gastric, Fig.1 (a)
Perforation, gastric, Fig.1 (b)