Radiologic Features and Prognosis of Gastric Perforation
DOI:
10.29303/jbt.v25i4.10132Published:
2025-10-13Downloads
Abstract
Gastric perforation carries high rates of morbidity and mortality, making it a critical surgical emergency. This systematic review presents recent evidence of radiological imaging, including its evaluation for the diagnosis of gastric perforation and its effect on patient prognosis. The search strategy included an extensive literature review from online databases, including PubMed and Google Scholar, with key phrases (such as "gastric perforation" and "diagnostic imaging"). A qualitative synthesis was done to evaluate the diagnostics of different imaging techniques and prognostic factors. The most relevant result is that Multidetector Computed Tomography (MDCT) continues to be the golden test, showing 82-90% accuracy in detecting perforation based on identifiable characteristics of the extraluminal free air. In summary, gastric perforation is a life-threatening condition where quick, accurate diagnosis with MDCT is vital for better outcomes, as delays exceeding 24 hours significantly raise mortality risk. This review highlights the importance of integrating MDCT into clinical protocols to speed up diagnosis and treatment, ultimately enhancing patient survival.
Keywords:
Diagnostic imaging, gastric perforation, MDCT, radiology, prognosis.References
AL Zoubi, M., El-Matbouly, M. A., Suliman, A. M., & AlBahrani, A. Z. (2022). Atypical cases of gastric perforation due to ischemia: Case series and review of literature. Journal of Surgery 7(6). https://doi.org/10.29011/2575-9760.001499
Andrian, A., Ikhsan, R., & Siregar, W. Y. (2022). Laporan kasus: Perforasi gaster. Averrous: Jurnal Kedokteran dan Kesehatan Malikussaleh, 8(1), 81–87. https://doi.org/10.29103/averrous.v8i1.7051
Assefa, G., Makuach, B., Tabor, B. B., & Hailu, S. S. (2025). Spontaneous gastric perforation in a 6-year-old child: A rare case report. Annals of Medicine & Surgery, 87 (7), 4672–4675. https://doi.org/10.1097/ms9.0000000000003443
Baca-Arzaga, A. A., Navarro-Chavez, H., Galindo, J., Santibanez-Juarez, J., Cardosa-Gonzalez, C., & Flores-Villalba, E. (2019). Transjejunal laparoscopic assisted ERCP in a patient with Roux-en-Y hepaticojejunostomy. Medicina (Lithuania), 55(8). https://doi.org/10.3390/medicina5508048
Bini, R., Ronchetta, C., Picotto, S., Scozzari, G., Gupta, S., Frassini, S., & Chiara, O. (2020). Importance of CT scan predicting clinical outcomes in gastrointestinal perforation. Annals of Translational Medicine, 8(21), 1421.
https://doi.org/10.21037/atm-20-2184
Celik, H., Kamar, M. A., Altay, C., Basara Akin, I., & Secil, M. (2022). Accuracy of specific free air distributions in predicting the localization of gastrointestinal perforations. Emergency Radiology, 29(1), 99–105. https://doi.org/10.1007/s10140-021-01990-7
Chen, T. Y., Liu, H. K., Yang, M. C., Yang, Y. N., Ko, P. J., Su, Y. T., Huang, R. Y., & Tsai, C. C. (2018). Neonatal gastric perforation: A report of two cases and a systematic review. Medicine (United States), 97(17). https://doi.org/10.1097/MD.0000000000010369
Del Gaizo, A. J., Lall, C., Allen, B. C., & Leyendecker, J. R. (2014). From esophagus to rectum: A comprehensive review of alimentary tract perforations at computed tomography. Abdominal Imaging, 39 (4), 802–823. https://doi.org/10.1007/s00261-014-0110-4
Drakopoulos, D., Arcon, J., Freitag, P., El-Ashmawy, M., Lourens, S., Beldi, G., Obmann, V. C., Ebner, L., Huber, A. T., & Christe, A. (2021). Correlation of gastrointestinal perforation location and amount of free air and ascites on CT imaging. Abdominal Radiology, 46 (10), 4536–4547. https://doi.org/10.1007/s00261-021-03128-2
Heo, S., Huh, J., Kim, J. K., & Lee, K. M. (2025). Delayed perforation after endoscopic resection of upper gastrointestinal tumors. Journal of Clinical Gastroenterology, 59(6), 542–548. https://doi.org/10.1097/MCG.0000000000002037
Huang, Y., Lu, Q., Peng, N., Wang, L., Song, Y., Zhong, Q., & Yuan, P. (2021). Risk factors for mortality in neonatal gastric perforation: A retrospective cohort study. Frontiers in Pediatrics, 9, 652139. https://doi.org/10.3389/fped.2021.652139
Huerta, C. T., & Perez, E. A. (2022). Diagnosis and management of neonatal gastric perforation: A narrative review. Digestive Medicine Research, 5, 27. https://doi.org/10.21037/dmr-21-105
Iacusso, C., Boscarelli, A., Fusaro, F., Bagolan, P., & Morini, F. (2018). Pathogenetic and prognostic factors for neonatal gastric perforation: Personal experience and systematic review of the literature. Frontiers in Pediatrics, 6. https://doi.org/10.3389/fped.2018.00061
Jain, N., Ratan, S. K., Ch, M., Neogi, S., Kumar, C., & Kumar, P. (2023). Neonatal gastric perforation: Review of 5 years’ experience in a tertiary care centre. Shasanka Shekhar Panda International Journal of Scientific Research Paediatric Surgery. https://doi.org/10.36106/ijsr
Jung, K., Woo, S.-Y., Kim, A. R., & Kim, H. (2023). Upper gastrointestinal tract perforation assessed by contrast-enhanced ultrasonography after oral Sonazoid administration in a stomach leakage mouse model. Ultrasonography, 42(2), 297–306. https://doi.org/10.14366/usg.22192
Kobayashi, T., Tabuchi, S., Koganezawa, I., Nakagawa, M., Yokozuka, K., Ochiai, S., Gunji, T., Ozawa, Y., Sano, T., Tomita, K., Chiba, N., Hidaka, E., & Kawachi, S. (2024). Early identification of patients with potential failure of nonoperative management for gastroduodenal peptic ulcer perforation. Digestive Surgery, 41(1), 24–29. https://doi.org/10.1159/000535520
Koto, K., Asrul, A., & A, M. (2016). Characteristic of gastric perforation type and the histopathology at Haji Adam Malik General Hospital Medan-Indonesia. Bali Medical Journal, 5(1), 186. https://doi.org/10.15562/bmj.v5i1.325
Kulinna-Cosentini, C., Hodge, J. C., & Ba-Ssalamah, A. (2024). The role of radiology in diagnosing gastrointestinal tract perforation. Best Practice & Research Clinical Gastroenterology, 70, 101928. https://doi.org/10.1016/j.bpg.2024.101928
Lanas, A., & Chan, F. K. L. (2017). Peptic ulcer disease. The Lancet, 390 (10094), 613–624. https://doi.org/10.1016/S0140-6736(16)32404-7
Lone, Y. A., Singh, S. K., Naaz, A., Chetan, C., & Kashyap, S. V. (2024). Tiny tummies, big challenges: A case series of neonatal gastric perforations. Cureus.
https://doi.org/10.7759/cureus.58149
Mahadevan, V. (2020). Anatomy of the stomach. Surgery (Oxford), 38(11), 683–686. https://doi.org/10.1016/j.mpsur.2020.08.005
Pouli, S., Kozana, A., Papakitsou, I., Daskalogiannaki, M., & Raissaki, M. (2020). Gastrointestinal perforation: Clinical and MDCT clues for identification of etiology. Insights into Imaging, 11(1). https://doi.org/10.1186/s13244-019-0823-6
Romano, S., Somma, C., Sciuto, A., Jutidamrongphan, W., Pacella, D., Esposito, F., Puglia, M., Mauriello, C., Khanungwanitkul, K., & Pirozzi, F. (2022). MDCT findings in gastrointestinal perforations and the predictive value according to the site of perforation. Tomography, 8(2), 667–687. https://doi.org/10.3390/tomography8020056
Sinnathamby, A., Low, J. M., Dale Lincoln Ser Keng, L., & Yvonne Peng Mei, N. (2021). Watch your numbers! Avoiding gastric perforation from feeding tubes in neonates. Pediatrics and Neonatology, 62 (6), 681–682. https://doi.org/10.1016/j.pedneo.2021.06.011
Søreide, K. (2016). Current insight into the pathophysiology of gastroduodenal ulcers: Why do only some ulcers perforate? Journal of Trauma and Acute Care Surgery, 80(6), 1045–1048. https://doi.org/10.1097/TA.0000000000001035
Sureka, B., Bansal, K., & Arora, A. (2015). Pneumoperitoneum: What to look for in a radiograph? Journal of Family Medicine and Primary Care, 4 (3), 477. https://doi.org/10.4103/2249-4863.161369
Velde, G., Ismail, W., & Thorsen, K. (2024). Perforated peptic ulcer. British Journal of Surgery, 111(9). https://doi.org/10.1093/bjs/znae224
Weledji, E. P. (2020). An overview of gastroduodenal perforation. Frontiers in Surgery, 7. https://doi.org/10.3389/fsurg.2020.573901
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