Diagnostic Approach for Suspected Bowel Perforation

Imaging Modalities

• The American College of Radiology notes that conventional radiography has limited overall diagnostic value for acute abdominal pain, with a sensitivity of 49% for bowel obstruction, but it maintains utility specifically for detecting pneumoperitoneum 1

Diagnostic Sensitivity and Specificity

• CT is the most sensitive imaging modality for detecting pneumoperitoneum, with a sensitivity of 89% for urgent abdominal conditions, and can identify the perforation site, as well as detect free air not visible on plain films 1

Diagnostic Approach for Abdominal Pain with Suspected Bowel Perforation

Clinical Findings and Diagnostic Tests

• A resonant liver percussion note is a critical physical examination finding that indicates pneumoperitoneum (free intraperitoneal air), which is best detected by an upright chest radiograph, as suggested by the American College of Gastroenterology 2

Diagnostic Imaging

• The presence of free air displaces the normal liver dullness, creating an abnormal resonant percussion note over the right upper quadrant, as noted in the Hepatology journal 2