Multidetector CT of Surgically Proven Blunt Bowel and Mesenteric Injury

Abstract

Blunt traumatic injury is one of the leading causes of morbidity and mortality in the United States. Unintentional injury represents the leading cause of death in the United States for all persons between the ages of 1 and 44 years. In the setting of blunt abdominal trauma, the reported rate of occurrence of bowel and mesenteric injuries ranges from 1% to 5%. Despite the relatively low rate of blunt bowel and mesenteric injury in patients with abdominal and pelvic trauma, delays in diagnosis are associated with increased rates of sepsis, a prolonged course in the intensive care unit, and increased mortality. During the past 2 decades, as multidetector computed tomography (CT) has emerged as an essential tool in emergency radiology, several direct and indirect imaging features have been identified that are associated with blunt bowel and mesenteric injury. The imaging findings in cases of blunt bowel and mesenteric injury can be subtle and may be seen in the setting of multiple complex injuries, such as multiple solid-organ injuries and spinal fractures. Familiarity with the various imaging features of blunt bowel and mesenteric injury, as well as an understanding of their clinical importance with regard to the care of the patient, is essential to making a timely diagnosis. Once radiologists are familiar with the spectrum of findings of blunt bowel and mesenteric injury, they will be able to make timely diagnoses that will lead to improved patient outcomes. RSNA, 2017.

Emergency CT of blunt abdominal trauma: experience from a large urban hospital in Southern China

“…Therefore, diagnostic radiologists should bear in mind to look for subtle CT signs of bowel and mesenteric injuries in every patient with blunt abdominal trauma. These signs include bowel wall transaction discontinuity, extraluminal air, focal bowel wall thickening, free peritoneal fluid, mesenteric infiltration or hematoma (Figures 11-14) (9). Unfortunately, these signs have low sensitivity or specificity.…”

Invited Commentary on “Multidetector CT of Surgically Proven Blunt Bowel and Mesenteric Injury”

“…Active mesenteric hemorrhage is an indication for surgical repair. In the patient population of Bates et al (1), the multidetector CT protocol included only the portal venous phase, with delayed images obtained in selected patients. This protocol is a time-honored approach, which has currently been replaced in many trauma centers across North America by a multiphase protocol that includes the arterial phase of multidetector CT or a CT angiogram.…”

“…The review article by Bates et al (1) on the imaging of blunt bowel and mesenteric injury covers a timely, interesting topic and is well written and illustrated. Blunt bowel and mesenteric injury is a difficult entity to detect with trauma imaging.…”

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

“…Blunt bowel and mesenteric injuries account for 1% of emergency trauma injuries and 1%-5% of blunt abdominal trauma, of which over 50% of cases are small bowel injuries (1,2). Bowel and mesenteric injuries have high morbidity and mortality rates in the trauma group due to non-specific symptoms and are often blurred in the context of multiple traumas, contributing to an increased risk of peritonitis and sepsis (3).…”

“…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).…”