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Due to advanced technology, computed tomography(CT) scan can make more precise diagnosis than ever even in the field of gastrointestinal (GI) tract. We previously reported accuracy rate of CT in diagnosing perforated gastro and duodenal ulcer, was more than 90%, which means that GI endoscopy and/or upper GI series are not required to confirm the perforated sites of upper GI tract in most cases. It's still uncertain, however, whether or not CT scan can accurately detect perforated site in patients (Pts) with small and large bowel perforation (SLBP). AIM: To clarify how precisely CT scan can detect perforated site in SLBP, and if CT scan can differentiate gastroduodenal perforation(GDP) from SLBP. Method: Since 2002 to 2010, Medical records of Pts with GDP and SLBP who underwent laparotomy or laparoscopic operation, were retrospectively reviewed. Results: one hundred and fifty-eight Pts (92 for GDP and 66 for SLBP) were operated for GDP and SLBP. Gastric cancer, gastric ulcer, and duodenal ulcer induced the perforation in all GDP Pts. Causes of SLBP were idiopathic(20 Pts), cancer-related perforation(15), diverticulum(8), trauma(7), foreign body(6), and others(10). Accuracy rate of CT scan in diagnosing site for GDP was 93.3%. On the other hand, the accuracy rate in SLBP was 84.6% (70.4% for small bowel and 89.7% for large bowel), and the rate decreased to 57.1% when limited to trauma. Two Pts who underwent laparotomy after diagnosed as SLBP on CT scan, had no perforation. One of them had trauma, and the other was finally diagnosed as pneumatosis intestinalis. There were no Pts who were at first diagnosed as GDP, but had actually SLBP. Mortality rate of GDP was 7.6%, while that of total SLBP, idiopathic, cancer-related, diverticulum, and trauma-related perforation, were 18.2%, 15.0%, 40.0%, 25.0%, and 0.0% respectively. Conclusion: When compared to GDP, accuracy rate to detect perforated site in SLBP, was decreased, especially in small bowel and trauma-related perforation. This decrease might be associated with little inflammatory change such as edema at perforated site soon after trauma and little intraluminal gas in the small bowel. When SLBP is suspected on CT scan, early exploratory laparotomy or laparoscopic examination should be considered. Once GDP is detected on CT scan, surgical or conservative therapy should be started as soon as possible. Gastrointestinal endoscopy and/or upper GI series were considered unnecessary in GDP.