Computed Tomographic Scanning and Selective Laparoscopy in the Diagnosis of Blunt Bowel Injury: A Prospective Study

Kitano, Mitsuhide; Sasaki, Junichi; Nagashima, Atsushi; Doi, Motomichi; Hayashi, Shinobu; Egawa, Tomohisa; Yoshii, Hiroshi

doi:10.1097/01.ta.0000159242.93309.f6

Cited by 55 publications

(41 citation statements)

References 28 publications

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“…The role of the CT scan in detecting BBMI remains controversial despite the improvements that have been made in terms of speed and image resolution with the advent of 32-and 64-detector helical scanners for the evaluation of intra-peritoneal and retro-peritoneal injuries [4,[11][12][13][14][15]. Our results indicate a high level of accuracy for detection of BBMI by CT scan, with a positive rate of 86%.…”

Section: Discussionsupporting

confidence: 51%

Management of blunt bowel and mesenteric injuries: Experience at the Alfred hospital

Alsayali¹,

Atkin²,

Winnett³

et al. 2009

Eur J Trauma Emerg Surg

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Section: Discussionsupporting

confidence: 51%

Management of blunt bowel and mesenteric injuries: Experience at the Alfred hospital

Alsayali¹,

Atkin²,

Winnett³

et al. 2009

Eur J Trauma Emerg Surg

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“…Saku et al 19 analyzed the CT findings of 12 patients with SBI perforation due to blunt trauma, 5 of whom were given a pre-surgical follow-up CT. All 9 patients that were examined > 8 h post-injury, but none of the 4 examined within 4 h, presented with extraluminal air, suggesting that the incidence of extraluminal air increases as time elapses, prompting the authors to recommend a repeat CT, particularly after 8 h, in suspect cases to increase sensibility 19 . Mitsuhide et al 20 suggested the use of a repeat CT scan or laparoscopy to prevent nontherapeutic laparotomy and delayed diagnosis in patients with suspected blunt SBI. In our series, the falsenegative CT scan rate was 13%, consistent with previously published rates 1,14,17,19 .…”

Section: Discussionmentioning

confidence: 99%

Blunt abdominal trauma with small bowel injury: are isolated lesions riskier than associated lesions?

Fraga

Silva

Almeida³

et al. 2008

Acta Cir. Bras.

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Purpose: The objective of this study was to compare patients with "isolated" blunt small bowel injury (SBI) to patients with multiple intra-abdominal injuries and analyze whether delayed laparotomy affected outcome. Methods: Medical records of patients that suffered a blunt SBI between 1994 and 2005 were reviewed. The patients were divided into two groups: those with isolated SBI and those with other associated intra-abdominal injuries ("non-isolated"). The method of diagnosis, time to operation, small bowel Organ Injury Scale (OIS) assessment (grade > 2), injury severity score (ISS), morbidity, and mortality were analyzed. Results: A total of 90 patients met the inclusion criteria, including 62 (68.9%) isolated cases and 28 (31.1%) non-isolated cases. Isolated cases required more supplementary diagnostic methods than the non-isolated cases. Non-isolated cases had a shorter diagnosis to treatment period (p < .01) and a higher ISS (mean 22.5 vs. 17.2 in "isolated" group). Morbidity (51.6% and 53.6%) and mortality (16.1% and 28.6%) did not differ significantly between the isolated and non-isolated groups. Delays in diagnosis were common in the isolated group, but this did not affect outcome. Patients with associated injuries, and higher ISS, had higher mortality. Conclusions: The presence of associated intra-abdominal injuries significantly affected the presentation and time to diagnosis of patients with SBI, but not morbidity or mortality. Delayed surgical treatment in the isolated cases was not associated with an increased incidence of complications. Patients inflicted with more severe associated injuries were less likely to survive the trauma.Key words: Trauma. Small bowel. Jejunum. Ileum. Intestinal fistula. RESUMOObjetivo: Comparar pacientes com lesão "isolada" de intestino delgado com pacientes com lesões abdominais "associadas" e analisar o quanto o retardo para indicação de laparotomia influenciou na evolução dos pacientes. Métodos: Foram revisados os prontuários de pacientes com trauma abdominal fechado e lesão de intestino delgado no período de 1994 a 2005, sendo os pacientes divididos em dois grupos: lesão "isolada" e lesões abdominais "associadas". Foram analisados os métodos diagnósticos, intervalo de tempo para a cirurgia, gravidade da lesão de delgado (grau > 2), ISS e morbimortalidade dos pacientes. Resultados: Noventa pacientes preencheram os critérios de inclusão, 62 (68,9%) no grupo "isolada" e 28 (31,1%) no "associada". Pacientes do grupo "isolada" necessitaram mais de métodos diagnósticos complementares. O tempo de diagnóstico até o tratamento foi significantemente menor no grupo "associada", e estes pacientes apresentavam ISS mais elevado (média de 22,5 versus 17,2 no grupo "isolada"). A morbidade e mortalidade nos grupos foram, respectivamente, 51,6% e 16,1% no grupo "isolada", e 53,6% e 28,6% no "associada", sem diferença estatística. Demora para o diagnóstico foi comum no grupo "isolada", porém sem agravar a evolução dos pacientes. Pacientes com lesões "associadas", quantificadas p...

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“…[15] In patients with a suspicion of hollow viscus injury, CT and diagnostic laparoscopy can be used for diagnosis. [19,20] In our study, we operated on five of eight patients with intestinal injury due to peritonitis-related signs, as revealed by repeated physical examination sessions. Diagnostic laparoscopy was performed to one of these patients.…”

Section: Discussionmentioning

confidence: 99%

Multivariate analysis of patients with blunt trauma and possible factors affecting mortality

Özpek

Yücel

Atak

et al. 2015

Ulus Travma Acil Cerrahi Derg

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Computed Tomographic Scanning and Selective Laparoscopy in the Diagnosis of Blunt Bowel Injury: A Prospective Study

Abstract: CT scanning and selective LP can prevent nontherapeutic laparotomy and delayed diagnosis in patients with suspected BBI.

Cited by 55 publications

References 28 publications

Management of blunt bowel and mesenteric injuries: Experience at the Alfred hospital

Management of blunt bowel and mesenteric injuries: Experience at the Alfred hospital

Blunt abdominal trauma with small bowel injury: are isolated lesions riskier than associated lesions?

Multivariate analysis of patients with blunt trauma and possible factors affecting mortality

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