Perforated colorectal neoplasms: Correlation of clinical, barium, and CT examinations

Findings on clinical, barium enema, and CT examinations in 24 patients with perforated colorectal neoplasms were retrospectively reviewed. In 12 patients with fever and leukocytosis, the clinical diagnoses were diverticulitis (n=8), appendicitis (n=2), pelvic inflammatory disease (n=2), and perforation of a known carcinoma (n=1). In 12 nontoxic patients, the clinical diagnoses were malignancy (n=8), obstruction (n=3) and an abdominal mass (n=1). In 18 barium enema examinations, the radiologic impression was uncomplicated carcinoma (n=9), perforated carcinoma (n=6), and diverticulitis (n=3). Twenty-two CT examinations revealed pericolic inflammation in all cases and macroperforation in 12. The primary tumor was evident in 14 patients, liver metastases were found in six, and ascites was present in three. CT findings influenced the management of patients initially suspected of having inflammatory conditions