CT imaging signs of surgically proven bowel trauma

Abstract

The objective of this study was to determine the incidence and interobserver agreement of individual CT findings as well as the bowel injury prediction score (BIPS) in surgically proven bowel injury after blunt abdominal trauma. This HIPAA-compliant retrospective study was IRB approved and consent was waived. All patients 14 years or older who sustained surgically proven bowel injury after blunt abdominal trauma between 1/1/2004 and 6/30/2015 were included. Admission trauma MDCT scans were independently interpreted by two abdominal fellowship-trained radiologists who recorded the following CT findings: intraperitoneal fluid, mesenteric hematoma/fat stranding, bowel wall thickening/hematoma, active intravenous contrast extravasation, free intraperitoneal air, bowel wall discontinuity, and focal bowel hypoenhancement. Subsequently, the electronic medical records of the included patients, admission abdominal physical exam results, admission white blood cell count, and findings at exploratory laparotomy of the included patients were recorded. Thirty-three patients met the inclusion criteria. The incidence and interobserver agreement of the CT findings were as follows: intraperitoneal fluid 93.9 %, kappa = 0.784 (good); mesenteric hematoma/fat stranding 84.8 %, kappa = 0.718 (good); bowel wall thickening/hematoma 42.4 %, kappa = 0.491 (moderate); active IV contrast extravasation 36.3 %, kappa = 1.00 (perfect); free intraperitoneal air 21.2 %, kappa = 0.904 (very good), bowel wall discontinuity 6.1 %, kappa = 1.00 (perfect); and focal bowel hypoenhancement 6.1 %, kappa = 0.468 (moderate). An absence of the specified CT findings was encountered in 9.1 % with surgically proven bowel injuries (kappa = 1.00, perfect). In our study, 9/16 patients or 56.3 % had a bowel injury prediction score (BIPS) of 2 or more as defined by McNutt et al. (J Trauma Acute Care Surg 78(1):105-111, 2014). The presence of intraperitoneal fluid and mesenteric hematoma/fat stranding are the most common CT findings in bowel injuries proven at laparotomy. A small percentage of patients have no abnormal CT findings. This grading system did not prove to be useful in our study likely due to our inherently small patient population; however, the use of BIPS deserves further investigation as it may help in identifying blunt bowel and mesenteric injury patients with often subtle or nonspecific CT findings.

The Role of Computed Tomography in the Assessment of Blunt Bowel and Mesenteric Injuries

“…Faget et al stated that these two findings were enough to confirm the presence of surgical intervention, with an OR of 128.9 (95% CI 9.5-999.9) and 140.5 (95% CI 9.3-999.9), respectively (8). Furthermore, in our study, interobserver agreement of these two findings was very good (k = 0.839 and 1.00, respectively), which is similar to a report done by LeBedis et al (20). Our study also manifested that two other MDCT findings that have significant correlation with surgical treatment were Janus signs and mesenteric stranding.…”

Multidetector CT of Surgically Proven Blunt Bowel and Mesenteric Injury

“…In their cohort, 86.7% of patients with a bowel injury prediction score of 2 or 3 had a bowel injury at surgery (35). However, in the results of a subsequent study of a smaller cohort, LeBedis et al (36) found that only 56.3% of patients with surgically proven bowel injury had a bowel injury prediction score of 2 or 3. Further investigation into this model is warranted.…”

Avoiding delayed diagnosis of significant blunt bowel and mesenteric injuries: Can a scoring tool make the difference? A 7-year retrospective cohort study

“…Patients with a BIPS ≥2 had a 19 times higher risk of sBBMI than patients with a lower score [23]. However, when applied to a retrospective series of 16 patients with surgically proven sBBMI [25], the BIPS was found to have a sensitivity of only…”