Evaluation of Bowel and Mesenteric Blunt Trauma with Multidetector CT

Abstract

Bowel and mesenteric injuries are detected in 5% of blunt abdominal trauma patients at laparotomy. Computed tomography (CT) has been shown to be accurate for the diagnosis of bowel and mesenteric injuries and is the diagnostic test of choice in the evaluation of blunt abdominal trauma in hemodynamically stable patients. Specific CT findings of bowel and mesenteric injuries include bowel wall defect, intraperitoneal and mesenteric air, intraperitoneal extraluminal contrast material, extravasation of contrast material from mesenteric vessels, and evidence of bowel infarct. Specific signs of mesenteric injury are vascular beading and abrupt termination of mesenteric vessels. Less specific signs of bowel and mesenteric injuries include focal bowel wall thickening, mesenteric fat stranding with focal fluid and hematoma, and intraperitoneal or retroperitoneal fluid. When only nonspecific signs of bowel and mesenteric injuries are seen on CT images, correlation of CT features with clinical findings is necessary. A repeat CT examination after 6-8 hours if the patient's condition is stable may help determine the significance of these nonspecific findings.

Multi Detector Computed Tomography in the Diagnosis of Bowel Injury

“…However this was seen in only 2 of 25 patients in a study by Killeen et al, as most patients have inadequate bowel wall opacification because of the often urgent nature of the CT scan examination [12]. While in a study by Brofman et al [13] it was seen in only 3/54 (6%) of patients.…”

“…Bowel wall discontinuity was seen in 4/54 (7%) patients in a study by Brofman et al They postulated that the relative infrequency of observations of this feature is likely due to small size of the discontinuities, which are evident at surgery only with careful inspection [13].…”

“…Whereas extraluminal gas was an infrequent finding in full-thickness bowel injury in previous reports [2,16], presence of pneumoperitoneum is strongly suggestive of full thickness bowel injury in the correct clinical setting. Brofman et al [13] stated that it was highly specific for the diagnosis of bowel perforation. It can also result from air introduced into the peritoneal cavity during diagnostic peritoneal lavage or Foley catheter placement in patients with intraperitoneal bladder rupture.…”

“…Diagnostic peritoneal lavage (DPL) has sensitivity greater than 90% for the detection of hemoperitoneum, but it is not specific and not reliable for the assessment of retroperitoneal injuries. Focused assessment with US in the trauma setting has a sensitivity of 86% and specificity of 98% for the detection of free intra-abdominal fluid, but it is nonspecific with regard to organ injury [13].…”

Missed mesenteric injury in blunt abdominal trauma: A potentially lethal error

“…Earlier studies reporting relatively lower rate of correct identification of mesenteric injuries largely predated MDCT. Currently, evidence from multiple recent studies reported better diagnostic accuracy with a sensitivity ranging from 69-95% and a specificity of 94-100% [7].…”