CT Findings of Acute Small-Bowel Entities

Sugi, Mark; Menias, Christine O.; Lubner, Meghan G.; Bhalla, Sanjeev; Mellnick, Vincent M.; Kwon, Matt; Katz, Douglas S.

doi:10.1148/rg.2018170148

Cited by 40 publications

(15 citation statements)

References 54 publications

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“…Radiological methods play an important role in the diagnosis of jejunal perforation in the absence of specific clinical symptoms. Lawson et al suggest that era "trauma scan" leads to reduction missing body injuries, but the bowel injuries are still the most commonly missed and the key to success in treatment is clinical doubt about intestinal trauma in severe trauma patients [12]. Matsushima and colleges analyzed 7,875 blunt trauma patients, they found blunt hollow viscus and mesenteric injury (BHVMI) in 67 (0.8%) patients who were divided in two groups: non-ischemic-BHVMI (perforation, laceration, and hematoma without devascularization) and ischemic-BHVMI (devascularization confirmed at laparotomy) [13].…”

Section: Discussionmentioning

confidence: 99%

“…Matsushima and colleges analyzed 7,875 blunt trauma patients, they found blunt hollow viscus and mesenteric injury (BHVMI) in 67 (0.8%) patients who were divided in two groups: non-ischemic-BHVMI (perforation, laceration, and hematoma without devascularization) and ischemic-BHVMI (devascularization confirmed at laparotomy) [13]. Authors found that even using an advanced imaging technique, the diagnosis of I-BHVMI can be delayed, with significant negative impact on patient outcome [12].…”

Section: Discussionmentioning

confidence: 99%

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Isolated jejunal perforation - hidden danger in blunt abdominal trauma

Doklestić

Vasin²,

Jovanović

et al. 2021

Srp Arh Celok Lek

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Introduction. Isolated jejunal perforation (IJP) without any associated injuries is rare in blunt abdominal trauma (BAT). It most commonly occurs in decelerating trauma. Diagnosis of traumatic intestinal perforation may be difficult in the first hours after injury so unrecognized ?missing? intestinal injuries incidences are as high as 24%. Unrecognized traumatic bowel perforation without adequate treatment leads to the intestinal leakage into the peritoneal cavity, making progress in secondary peritonitis and potentially lethal complications. Case outline. We presented the case of 43 years old women injured in road traffic accident. She was admitted to emergency surgery after diagnostic procedures according to the protocol for trauma. Initial examination, and body computed tomography (CT) revealed orthopedic injuries. Daily monitoring and follow-up examinations were done, she did not complain of any discomfort nor pain in the abdomen and there were no signs of abdominal injury. Two days after trauma, follow-up abdominal CT revealed highly suspected jejunum perforation, still with no signs of pneumoperitoneum. Laparotomy was performed and diagnosis of IJP was confirmed. Bowel perforation was surgically closed in two layers, followed by drainage of septic collections, abdominal saline lavage and primary abdominal closure. The patient was discharged on the seventh postoperative day without complications. Conclusion. In the case of BAT due to severe traumatic force in patient with nonspecific clinical signs of abdominal trauma on initial clinical and radiological examination, follow-up in a short period is necessary, to detect hidden jejunal perforation. Surgery is a life-saving for those patients and treatment of these injuries usually require simple operative procedures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Isolated jejunal perforation - hidden danger in blunt abdominal trauma

Doklestić

Vasin²,

Jovanović

et al. 2021

Srp Arh Celok Lek

View full text Add to dashboard Cite

show abstract

“…Generalized vasospasm may be obvious as narrowing of IVC, aorta and mesenteric vessels resulting in decreased enhancement of affected bowel segments and occasionally other organs (liver, spleen and pancreas) [74]. Bowel wall thickness ranges from unchanged in earliest stages to markedly thinned in an advanced stage [40,74].…”

Section: Non-occlusivementioning

confidence: 99%

“…Mixed arterial and venous ischemia are also infrequently seen in association with other conditions including trauma, chemotherapy, irradiation, drug induced, corrosive injury, lead poisoning, iatrogenic, etc. [74] (Figs. 22,23,24,25,26,27,28).…”

Section: Mixed (Strangulation) and Other Miscellaneous Causesmentioning

confidence: 99%

Many faces of acute bowel ischemia: overview of radiologic staging

et al. 2021

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Acute bowel ischemia (ABI) can be life threatening with high mortality rate. In spite of the advances made in diagnosis and treatment of ABI, no significant change has occurred in the mortality over the past decade. ABI is potentially reversible with prompt diagnosis. The radiologist plays a central role in the initial diagnosis and preventing progression to irreversible intestinal ischemic injury or bowel necrosis. The most single imaging findings described in the literature are either non-specific or only present in the late stages of ABI, urging the use of a constellation of features to reach a more confident diagnosis. While ABI has been traditionally categorized based on the etiology with a wide spectrum of imaging findings overlapped with each other, the final decision for patient’s management is usually made on the stage of the ABI with respect to the underlying pathophysiology. In this review, we first discuss the pathologic stages of ischemia and then summarize the various imaging signs and causes of ABI. We also emphasize on the correlation of imaging findings and pathological staging of the disease. Finally, a management approach is proposed using combined clinical and radiological findings to determine whether the patient may benefit from surgery or not.

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“…In addition, CT signs associated with hypotension complex can be important indicators of systemic hypotension, which may facilitate the differential diagnosis. Shock bowel has a mortality rate of up to 70% [23][24][25][26][28][29][30][31].…”

Section: Bowel Hypoperfusion (Shock Bowel)mentioning

confidence: 99%

Computed tomography imaging of septic shock. Beyond the cause: the “CT hypoperfusion complex”. A pictorial essay

Serafino

Viscardi²,

Iacobellis

et al. 2021

Insights Imaging

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Septic shock is a medical emergency that represents one of the most important underlying causes for presentation to the Emergency Department. Sepsis is defined as organ dysfunction, life-threatening event caused by a deregulated inflammatory host response to infection, with a mortality risk ranging from 10 to 40%. Early sepsis identification is the cornerstone of management and diagnostic imaging can play a pivotal role in this clinical context. The choice of imaging modality depends on several factors, associated with the clinical condition and the presence or absence of localising signs and symptoms. The diagnostic accuracy of contrast-enhanced total-body CT has been well established during septic shock, allowing for a rapid, panoramic, and detailed study of multiple body areas, simultaneously. The aim of this article is to illustrate the controversial CT hypoperfusion complex in patients with septic shock, characterised by the following imaging features: decreased enhancement of the viscera; increased mucosal enhancement; luminal dilation of the small bowel; mural thickening and fluid-filled loops of the small bowel; the halo sign and flattening of the inferior vena cava; reduced aortic diameter; peripancreatic oedema; abnormal parenchymal perfusion; and other controversial findings that are variably associated with each other and reversible during the early stages. Increasing physicians’ awareness of the significance of these findings could prompt alternative approaches to the early assessment and management of septic shock. In this perspective, CT imaging represents a useful tool for a complete, rapid and detailed diagnosis of clinically suspected septic shock, which can be used to improve patient outcomes.

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CT Findings of Acute Small-Bowel Entities

Cited by 40 publications

References 54 publications

Isolated jejunal perforation - hidden danger in blunt abdominal trauma

Isolated jejunal perforation - hidden danger in blunt abdominal trauma

Many faces of acute bowel ischemia: overview of radiologic staging

Computed tomography imaging of septic shock. Beyond the cause: the “CT hypoperfusion complex”. A pictorial essay

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