Multidetector CT Findings of Bowel Transection in Blunt Abdominal Trauma

Abstract

ObjectiveThough a number of CT findings of bowel and mesenteric injuries in blunt abdominal trauma are described in literature, no studies on the specific CT signs of a transected bowel have been published. In the present study we describe the incidence and new CT signs of bowel transection in blunt abdominal trauma.Materials and MethodsWe investigated the incidence of bowel transection in 513 patients admitted for blunt abdominal trauma who underwent multidetector CT (MDCT). The MDCT findings of 8 patients with a surgically proven complete bowel transection were assessed retrospectively. We report novel CT signs that are unique for transection, such as complete cutoff sign (transection of bowel loop), Janus sign (abnormal dual bowel wall enhancement, both increased and decreased), and fecal spillage.ResultsThe incidence of bowel transection in blunt abdominal trauma was 1.56%. In eight cases of bowel transection, percentage of CT signs unique for bowel transection were as follows: complete cutoff in 8 (100%), Janus sign in 6 (100%, excluding duodenal injury), and fecal spillage in 2 (25%). The combination of complete cutoff and Janus sign were highly specific findings in patients with bowel transection.ConclusionComplete cut off and Janus sign are the unique CT findings to help detect bowel transection in blunt abdominal trauma and recognition of these findings enables an accurate and prompt diagnosis for emergency laparotomy leading to reduced mortality and morbidity.

Multidetector CT of Surgically Proven Blunt Bowel and Mesenteric Injury

“…The Janus sign refers to adjacent enhancing and nonenhancing loops of bowel. The Janus sign has been described as specific for bowel injury (42) (Figs 4, 5). Focal mucosal hyperenhancement of the bowel can be seen in bowel ischemia, particularly after reperfusion from an arterial injury (43).…”

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

“…The rate of surgical intervention would be raised 6-and 3-fold, respectively, with the presence of these findings. The study of Cho et al reported that 75% of patients with bowel transection showed a Janus sign near the site; therefore, it might be considered as a specific sign of bowel injury (6). With regards to mesenteric stranding, several studies showed that this feature was high sensitive but low specific to mesenteric injury (1,4).…”

“…Reduced bowel-wall enhancement was confirmed when compared with that of the adjacent bowel wall (Figure 2). Janus sign was defined as a focal of increased-enhancement bowel loop adjacent to a focal decreased-enhancement one (6).…”

“…Nevertheless, the role of this modality has still been mismatched in the diagnosis of bowel and mesenteric injuries in previous reports (1,5,6). Additionally, the application of MDCT results in certain conditions in separating surgery from conservative therapy is also problematic (5).…”

Jejunal transection following trivial trauma: Case report and review of literature

“…Severe forms of bowel injury are rare and if reported usually follow high energy impact as seen in sports related injury [1] , [2] , motor vehicle accident [3] , [4] , [5] , [6] and falls from heights. Bowel transection has been reported following supposedly trivial trauma like coughing [7] fall from a bicycle [8] , child abuse [9] , [10] , hitting an iron fence bar [11] , handle bar trauma and others [12] .…”