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Year : 2021  |  Volume : 27  |  Issue : 2  |  Page : 116-121

Diagnostic validity of x-rays in detection of hollow viscus perforation

Department of General Surgery, Medical College Hospital, Kozhikode, Kerala, India

Correspondence Address:
Dr. Ajay M Jose
Medical College Hospital, Kozhikode, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ksj.ksj_23_21

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Introduction: Identification of a small amount of free intra-abdominal gas remains one of the most significant signs in a perforated viscus. This paper tried to evaluate the sensitivity of chest radiographs in the detection of hollow viscus perforation and to compare the sensitivity of left lateral decubitus view and chest radiograph posteroanterior (PA) view in the detection of pneumoperitoneum. Methodology: Diagnostic validation study was conducted in sixty patients with clinical signs of peritonitis and strongly suspected to have perforation were evaluated with chest radiograph PA view and left lateral decubitus view in search of pneumoperitoneum and confirmed during laparotomy. Results: Out of sixty patients, 54 had gastrointestinal (GI) perforation and 42 out of those 54 were diagnosed in plain chest radiograph. Rest 12 required contrast enhancement computerised tomogam for diagnosis. There was only one case reported with chest radiograph showing pneumoperitoneum and the patient without any breach in the GI tract. Thirty patients with perforation took a left lateral decubitus view which showed free air only in 23 cases. Conclusion: Sensitivity of left lateral decubitus was around 76.6%. Overall, the sensitivity of plain chest radiograph in diagnosing perforation was 77% with specificity 83%, positive predicative value 97.6%, negative predicative value 29.4% and an accuracy of 79.6%.

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