Morbidity and mortality from perforations of the gastrointestinal tract remain high despite antibiotics and other refinements in treatment. The typical clinical presentation of perforation may often be altered or masked by accompanying circumstances, and subsequent delay in diagnosis contributes significantly to the problem of early and adequate management.
Free air in the peritoneal cavity is indicative of the condition; however, pneumoperitoneum can be demonstrated in only about 50% of perforations of the upper gastrointestinal tract. Furthermore in the immediate postoperative period free air may remain in the abdomen for as long as a week. Collection of air in the fundus of the stomach or in the splenic flexure of the colon may make it difficult to identify free air under the left side of the diaphragm. Roentgenographic observations have been relied upon for diagnosis, although some severely ill patients tolerate the upright position poorly and their condition may be jeopardized
DIAGNOSTIC TEST FOR INTESTINAL PERFORATION. JAMA. 1965;193(12):1050–1051. doi:10.1001/jama.1965.03090120058019
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