Accuracy of clinical, laboratory, and computed tomography findings for identifying hollow viscus injury in blunt trauma patients with unexplained intraperitoneal free fluid without solid organ injury

Jost, Evan; Roberts, Derek J.; Penney, Todd; Brunet, Grant; Ball, Chad G.; Kirkpatrick, Andrew W.

doi:10.1016/j.amjsurg.2017.03.016

Cited by 13 publications

(20 citation statements)

References 24 publications

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“…Another limitation is that our control group included patients with other surgical indications and HVMI that did not require surgical correction. We also did not take into account the quantity and quality of free fluid without solid organ injury, where the number of Hounsfield Units, blood vs low density fluid such as bile, has been reported to be an accurate sign of bowel injury [35,36]. Furthermore, the present study failed to obtain remarkable results for low risk patients.…”

Section: Discussionmentioning

confidence: 73%

Traumatic hollow viscus and mesenteric injury: role of CT and potential diagnostic–therapeutic algorithm

et al. 2020

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Despite its rarity, traumatic hollow viscus and mesenteric injury (HVMI) have high mortality and complication rates. There is no consensus regarding its best management. Our aim is to evaluate contrast enhanced CT (ceCT) in the screening of HVMI and its capability to assess the need for surgery. All trauma patients admitted to an urban Level 1 trauma center between 2010 and 2018 were retrospectively evaluated. Patients with ceCT scan prior to laparotomy were included. Patients requiring surgical repair of HVMI and a ceCT scan consistent with HVMI were considered true positives. Six ceCT scan criteria for HVMI were used; at least one criterion was considered positive for HVMI. Sensitivity (Sn), specificity (Sp), predictive values (PV), likelihood ratios (LR) and accuracy (Ac) of ceCT of single ceCT criteria and of the association of ceCT criteria were calculated using intraoperative findings as gold standard. Therapeutic time (TT), death probability (DP), and observed mortality (OM) were described. 114 of 4369 patients were selected for ceCT accuracy analysis; 47 were considered true positives. Sn of ceCT for HVMI was 97.9%, Sp 63.6%, PPV 66.2%, NPV 97.6%, + LR 2.69, −LR 0.03, Ac 78%; no single criterion stood out. The association of four or more criteria improved ceCT Sp to 98.5%, PPV to 95.6%, + LR to 30.5. Median TT was 2 h (IQR: 1–3 h). OM was 7.8%—not significantly higher than overall OM. CeCT in trauma has become a reliable screening test for HVMI and a valid exam to select HVMI patients for surgical exploration.

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Section: Discussionmentioning

confidence: 73%

Traumatic hollow viscus and mesenteric injury: role of CT and potential diagnostic–therapeutic algorithm

et al. 2020

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“…Various publications describe the potential role of different maneuvers to diagnose HVI following blunt trauma. Physical examination, abdominal x-ray, ultrasound, computed tomography, and diagnostic laparoscopy may each contribute to the diagnosis, with varying sensitivity and specificity (1)(2)(3)(4)(5)7,12). Our patient had evidence of major intra-abdominal injury from history and physical examination, with findings of frank peritonitis.…”

Section: Discussionmentioning

confidence: 85%

“…Hollow viscus injury (HVI) following blunt trauma is challenging and uncommon, presenting in 0.3-9% of cases (1)(2)(3)(4)(5)(6)(7). HVI may involve serosal lacerations, mural hematomas, or ruptures following an acute rise in intraluminal pressure (1)(2)(3)(4)8).…”

Section: Introductionmentioning

confidence: 99%

“…HVI with perforation occurs in less than 1.0% of patients with blunt abdominal trauma. (4,5,7) Although compression of the intestine between the abdominal wall and the spine is considered the primary mechanism of injury (1,2,(6)(7)(8), a combination of factors is probably involved. About 25% of patients who have surgery for presumed HVI have more than one site of bowel injury (2) and 21.4% have associated solid visceral injury (2).…”

Section: Introductionmentioning

confidence: 99%

“…No individual or combination of diagnostic tests, including physical examination, x-ray, ultrasound, and computed tomography (1,4,8), have been shown to accurately detect colonic injury (4). Certain CT findings including focal wall thickening, bowel wall hematoma, enteral contrast extravasation, discontinuity of bowel wall, foci of air near a hollow viscus, frank pneumoperitoneum, and intraperitoneal fluid suggest HVI (1,2,4,6,7). Simple closure may be appropriate in the case of an isolated perforation with minimal contamination (2,10).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Isolated Cecal Rupture after Blunt Abdominal Trauma

Bedada¹,

Riddle²,

Eshetu³

et al. 2020

Ann Afr Surg.

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Cecal perforation following blunt abdominal trauma is an uncommon and challenging injury. We report a 19-year-old HIV-positive woman who presented with abdominal pain after a high-speed motor vehicle crash. Abdominal exam revealed a seatbelt sign with evidence of peritonitis; Focused Assessment with Sonography for Trauma showed free intraperitoneal fluid. After fluid resuscitation and antibiotics, the patient was taken for urgent laparotomy. Intraoperatively, we discovered hemoperitoneum and an isolated rupture of the cecum. A right hemicolectomy with end-to-end ileo-transverse colon anastomosis was performed. Her only significant postoperative complication was a superficial wound infection. We review the epidemiology of hollow viscus injury in blunt trauma and discuss important considerations in diagnosis and treatment. Keywords: Blunt abdominal trauma, Cecal rupture, HIV positive, Hollow viscus

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The Impact of Prior Laparotomy and Intra‐abdominal Adhesions on Bowel and Mesenteric Injury Following Blunt Abdominal Trauma

et al. 2018

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Accuracy of clinical, laboratory, and computed tomography findings for identifying hollow viscus injury in blunt trauma patients with unexplained intraperitoneal free fluid without solid organ injury

Cited by 13 publications

References 24 publications

Traumatic hollow viscus and mesenteric injury: role of CT and potential diagnostic–therapeutic algorithm

Traumatic hollow viscus and mesenteric injury: role of CT and potential diagnostic–therapeutic algorithm

Isolated Cecal Rupture after Blunt Abdominal Trauma

The Impact of Prior Laparotomy and Intra‐abdominal Adhesions on Bowel and Mesenteric Injury Following Blunt Abdominal Trauma

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