Effectiveness of X-ray film in diagnosing peptic ulcer perforation

Abstract

Purpose: A retrospective case-control study was undertaken to assess the diagnostic efficacy of X-ray film in detecting peptic ulcer perforation (PUP). Materials and Methods: The study retrieved demographic data, perioperative observations, and postoperative results of 353 patients from the hospital repository. These individuals were categorized into two cohorts depending on the detection of intraperitoneal free air on X-ray imaging. Results: The study cohort exhibited a median age of 57 years (interquartile range: IQR 38-71), comprising predominantly males (82.4%). Intraperitoneal free air was evident in 73.1% of patients on X-ray imaging. In the multivariate analyses of the respective groups, time interval and diabetes mellitus (DM) emerged as independent risk factors. Notably, the sensitivity of X-ray film heightened with prolonged duration between symptom onset and emergency department admission, while specificity increased in the presence of DM. Conclusion: The imperative for supplementary imaging modalities in conjunction with clinical assessment is apparent in the diagnostic approach to PUP. Nonetheless, the fluctuation in sensitivity and specificity of X-ray film concerning DM and the duration from symptom onset to emergency department admission warrants careful consideration. Especially in cases where clinical suspicion of PUP exists despite the absence of intraperitoneal free air on X-ray, the utilization of advanced diagnostic techniques is advocated.