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What is the gold standard for diagnosis of small bowel perforation? What other modalities are also considered?
CT is the gold standard. Other modalities include focused assessment of sonography for trauma (FAST) scans and plain film X-rays.
- Pneumoperitoneum and moderate amount of intraperitoneal free fluid (water density) is in keeping with bowel perforation. There is a particularly abnormal appearing loop of small bowel that is transversely oriented across the central abdomen. This appears moderately distended, measuring 2.5 cm in maximum dimension and has internal increased density suggestive of blood.
- More diffuse small bowel wall thickening in the setting of hypovolaemia suggests "shock bowel". Diffuse mesenteric stranding in keeping with mesenteric traumatic injury.
- Bulky left adrenal gland suspicious of haemorrhage.