Current Diagnostic Approaches Lack Sensitivity in the Diagnosis of Perforated Blunt Small Bowel Injury: Analysis from 275,557 Trauma Admissions from the EAST Multi-Institutional HVI Trial

Fakhry, Samir M.; Watts, Dorraine D.; Luchette, Fred A.

doi:10.1097/01.ta.0000046256.80836.aa

Cited by 226 publications

(234 citation statements)

References 23 publications

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“…However, if free fluid is present without concomitant CT scan evidence of solid organ injury, its etiology should be evaluated and other CT signs of GI perforation should be searched for [7]. Free fluid without solid organ injury was found by Fakhry and coworkers to be associated with an 84.2% incidence of small bowel injury [17]. The combination of free fluid and pneumoperitoneum increased the sensitivity in detecting perforated small bowel injury to 97% [9].…”

Section: Discussionmentioning

confidence: 99%

Multi Detector Computed Tomography in the Diagnosis of Bowel Injury

2012

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Bowel Injuries are uncommonly associated with traumatic abdominal injuries. However, they are associated with significant morbidity and mortality and require operative intervention unlike solid organ injuries. Hence, early diagnosis is of paramount importance. Computed tomographic (CT) scan is a well-established and highly accurate imaging modality for the detection of solid organ injury after blunt abdominal trauma. However, its role in diagnosing hollow viscus injury remains controversial. The aim of our study was to analyze the accuracy of multidetector CT (MDCT) in the diagnosis of bowel injury. Imaging features of surgically proven cases of bowel injury were identified over 8-year period (i.e., from January 2003 to December 2010) and were retrospectively analyzed. There were 32 patients with age range of 3-90 years. There was only one female. Sensitivity of various CT signs specific to bowel injury (i.e., extravasation of contrast and discontinuity of bowel wall) was 15.62, and 28.12%, respectively. While that of signs suggestive of bowel injury were pneumoperitoneum, 62.5%; gas in the vicinity, 40.62%; bowel wall hematoma, 21.87%; bowel wall thickening, 75%; ascites, 78.12%; mesenteric hematoma, 46.87%; and mesenteric stranding, 40.62%. Based on the major and minor signs, a diagnosis of bowel injury could be made in all patients except one. The minor signs showed a higher sensitivity than the major signs. Hence, we recommend that multidetector CT should be used as the modality of choice in case of patients with suspected bowel injury. We also suggest that the minor signs should be given as much importance as the major signs.

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Section: Discussionmentioning

confidence: 99%

Multi Detector Computed Tomography in the Diagnosis of Bowel Injury

2012

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“…Bhatti et al found stab injury as the commonest mode of injury affecting mostly large intestine (40%) 4 . Fakhry SM et al showed that most of abdominal injuries affect the jejunum (64%) 19 .…”

Section: Discussionmentioning

confidence: 99%

Primary Repair of Traumatic Gut Injury Without Diversion in Casualty Department of Dhaka Medical College Hospital

Matubber

Billah²,

Huq

et al. 2014

Faridpur Med Coll J

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:Colon is one of the most commonly injured viscera followed by small gut and liver in abdomen for which management becomes complicated had the type and severity of injury not been assessed properly. With improved facilities in patient care and proper use of antibiotics the inclination is directed towards primary repair of colon without diversion. This study was aimed to assess the efficacy of primary repair in a tertiary hospital. A number of 50 patients of traumatic gut injury from 15-50 years (31.18 ± 9.38 years) mainly presenting with RTA with blunt trauma abdomen (54.0%) and different types of stab injury (40.0%) were managed with primary repair in the department of casualty in Dhaka Medical College Hospital, Dhaka between the period of January to June 2009. On admission more than half (52.0%) had hypotension, 70.0% distended abdomen, 84.0% tender abdomen, 58.0% presented with abdominal rigidity while 80% of them had perforation of the small and 20% had the same in large gut. After primary repair, only 6% developed chest infection and 4% developed wound infection. The findings suggest that primary repair without diversion in the treatment of traumatic gut injury can be performed among patients admitted in our hospitals.

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“…Several studies have pointed out, that bruising in a seat belt pattern was associated with intra-abdominal injury in 20-60% of cases [6]. The risk of perforated bowel injury increased by a 2.4 factor whenever seat belt bruising was detected [7]. In contrast, isolated findings of bruising without associated abdominal pain or guarding, was associated with low risk of intra-abdominal injury [8].…”

Section: Case Presentationmentioning

confidence: 92%

Jejunal injuries in a young male’s blunt abdominal trauma

Mica¹,

Jensen²,

Pothmann³

et al. 2016

Trauma Emerg Care

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Missed hollow viscus injuries increase the mortality rate in trauma patients specifically in polytraumatized patients. A 18 years old young male patient suffered a high velocity (ca.50 km/h, 31mi/h) car crash with deployment of the airbags. The hemodynamically stable patient did not suffer any intracranial injuries but complained about severe pain in the lower abdomen. The primary survey was misleading. CT demonstrated minimal accumulation of free intraabdominal fluid. Due to persistently severe pain, the patient was taken to the operating room for diagnostic laparoscopy followed by exploratory laparotomy. Jejunal perforation was detected and was surgically treated.In conclusion, following blunt abdominal trauma, operative management is even recommended in patients who present with significant abdominal pain but minimal or absence of pathological findings in abdominal CT-scan imaging.

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Current Diagnostic Approaches Lack Sensitivity in the Diagnosis of Perforated Blunt Small Bowel Injury: Analysis from 275,557 Trauma Admissions from the EAST Multi-Institutional HVI Trial

Abstract: Alone or in combination, current diagnostic approaches lack sensitivity in the diagnosis of perforated SBI. Improvements in diagnostic methods and approaches are needed to ensure the prompt diagnosis of this uncommon but potentially devastating injury.

Cited by 226 publications

References 23 publications

Multi Detector Computed Tomography in the Diagnosis of Bowel Injury

Multi Detector Computed Tomography in the Diagnosis of Bowel Injury

Primary Repair of Traumatic Gut Injury Without Diversion in Casualty Department of Dhaka Medical College Hospital

Jejunal injuries in a young male’s blunt abdominal trauma

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