The Utility of Abdominal CT to Judge the Operative Indication for Upper Gastrointestinal Tract Ulcer Perforation

Yukiyasu Okamura, Akio Harada, Yoshikuni Inokawa, Takashi Sugae, Takashi Shirota, Tsunenobu Takase, Shigeki Nakayama, Masaki Kajikawa and Toyohisa Yaguchi

Department of Surgery, Aichi Prefectural Koseiren Kainan Hospital

Background: Upper gastrointestinal tract perforation is now positively treated conservatively, but no objective index exists for shifting to surgical treatment. We reviewed the use of abdominal Computed Tomography (CT) in determining operative indications for surgery. Methods: We reviewed leukocyte count, CRP, and the amount of ascites in abdominal CT in 53 cases from February 1998 to October 2002. Conservative treatment was considered for patients less than 70 years old without severe underlying disease and in whom no ascites was recognized exceeding 2 cm in CT. We conducted this treatment plan for 20 cases from November 2002 until October 2004 and reviewed feasilibity. Results: Eighteen of 20 cases met our treatment criteria and two dropped out. Death occurred in one, who required emergency surgery due to a large amount of ascites from the beginning. Discussion: CT findings are more useful than leukocyte count or CRP in judging operative indications in upper gastrointestinal tract perforation.

Key words
upper gastrointestinal tract perforation, peritonitis, computed tomography, ascites

Reprint requests
Yukiyasu Okamura Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center
1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, 411-8777 JAPAN

Accepted
October 25, 2006

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