Rupture of the bowel after blunt abdominal trauma: diagnosis with CT.

Mirvis, SE; Gens, David; Shanmuganathan, Kathirkamanathan

doi:10.2214/ajr.159.6.1442385

Cited by 163 publications

(63 citation statements)

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“…Furthermore, in traumatic bowel perforation, mesenteric pneumoperitoneum may be useful for localizing the damaged intestinal tract occurring more commonly in the small bowel [21]. In contrast, mesenteric air is more commonly missing than free pneumoperitoneum in bowel perforation (these two findings were lacking in 29.6 % of bowel perforations in our study), as already reported in the literature [8,21]. Visualization of a bowel wall discontinuity had the best positive predictive values of surgical BBMI (PPV=95 %) ) and delayed (c) phases, in a 35-year-old man after motor vehicle crash.…”

Section: Discussionsupporting

confidence: 76%

“…It is highly reliable for intra-abdominal solid organ injury diagnosis and is now considered accurate in the diagnosis of bowel and mesenteric injuries complicating blunt abdominal trauma [5]. Many CT findings of BBMI have been reported, some of which are specific, but most are only suggestive, and the exact diagnostic performance of CT remains debatable, with experienced readers yielding more accurate diagnoses [2,[6][7][8][9][10][11][12]. Moreover, some BBMI, e.g.…”

Section: Introductionmentioning

confidence: 99%

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Value of CT to predict surgically important bowel and/or mesenteric injury in blunt trauma: performance of a preliminary scoring system

et al. 2015

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Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Value of CT to predict surgically important bowel and/or mesenteric injury in blunt trauma: performance of a preliminary scoring system

et al. 2015

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“…10 CT more clearly demonstrates the anatomy and has been reported to be diagnostic of bowel injury in 88% of blunt abdominal trauma cases. 11 However, CT may add to delay in surgery when a laparotomy is necessary.…”

Section: Discussionmentioning

confidence: 99%

Isolated Duodenal Rupture due to Go-Karting Accidents – Braking News

Thomas

Basu

Gulati

et al. 2009

annals

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Ann R Coll Surg Engl 2009; 91: 340-343 340Go-karting is a very popular recreational activity in the UK with easy access to race tracks throughout the country. However, due to the relatively high speeds and lack of seat belt restraint requirements, there are numerous injuries and a significant number of deaths world-wide each year.1 Small bowel injury as a result of any blunt abdominal trauma is rare (3.6%).2 Cases of isolated small bowel injury after blunt trauma are even less common (1%) with the majority (58-70%) associated with multiple injuries.2,3 Isolated duodenal injuries are extremely uncommon.We present three cases of isolated duodenal ruptures, of the D3/D4 segment, due to go-karting accidents occurring over a period of 5 months. Difficulties in clinical diagnosis of duodenal injury and the likelihood of significant complications 2,3 justifies maintaining a high index of suspicion with early investigation for patients attending with similar presentations. Case reports Case 1A healthy 29-year-old woman was brought to the accident and emergency department complaining of epigastric and right upper quadrant pain after crashing a go-kart into the side barriers of the track. Blunt abdominal trauma was sustained as the steering wheel impacted on her epigastrium during the crash. She was normotensive and had a pulse rate of 92 beats/min. There was tenderness in the right upper quadrant; however, the abdomen was soft and there was no guarding. Her white cell count (WCC) was raised at 26 × 10 9 cells/l and the haemoglobin (Hb) was normal at 12.1 g/dl. The amylase level was normal at 51 U/l. Chest and plain abdominal radiographs were unremarkable with no free air demonstrated.She was admitted and had an ultrasound scan of the abdomen the next day which demonstrated minimal perihepatic fluid (Fig. 1A) and normal solid organs. Blood investigations showed improvement and the WCC reduced to 12.1 × 10 9 cells/l. The patient remained stable with no worsening of her signs or symptoms. It was, therefore, decided to treat her conservatively and a computed tomography (CT) scan was performed to exclude any serious injury. This demonstrated a rupture in the wall of the early third part of duodenum, air pockets and a fluid collection in the retroperitoneal spaces (Fig. 1B), particularly in the retropancreatic and right anterior pararenal spaces. Some Imaging, Queen Elizabeth Hospital NHS Trust, London, UK ABSTRACT INTRODUCTION Isolated duodenal injury due to blunt abdominal trauma is extremely rare. We present a series of three such injuries due to go-karting accidents, which presented to our hospital over 5 months. CASE REPORTS Between October 2007 and February 2008, three cases of D3/D4 duodenal rupture presented to our hospital after go-karting accidents. Trauma occurred as a result of the steering wheel impacting on the abdomen. All patients presented similarly with symptoms of epigastric and right upper quadrant pain. In all cases, computed tomography scanning was highly suggestive of duodenal injury and, in particular, ...

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“…Multidetector CT is more sensitive and specific than diagnostic peritoneal lavage, abdominal US, and clinical examination for the diagnosis of bowel and mesenteric injuries, and it has become the diagnostic test of choice for the evaluation of blunt abdominal trauma in hemodynamically stable patients. 17,19 The results of various studies show sensitivities of 69%-95% and specificities of 94%-100% for the diagnosis of bowel and mesenteric injuries with CT. [20][21][22][23] The use of multidetector CT for evaluation of blunt abdominal trauma helps significantly reduce the amount of time required to perform the examination and the number and severity of motion artefacts and helps improve blood vessel opacification and solid organ enhancement.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of intestinal injuries from blunt abdominal trauma

Manoranjan¹,

S²,

Chandrashekar³

2017

Int Surg J

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Background: To Evaluate the cause, presentation, anatomical extent, diagnostic method, management and outcome of intestinal injuries from blunt abdominal injuries.Methods: The study included 40 patients who underwent laparotomy for intestinal injuries from blunt abdominal trauma over a period of 1 year. A retrospective study was conducted, and the patients were evaluated with respect to the cause, presentation, anatomical distribution, diagnostic methods, associated injuries, treatment and mortality.Results: 40 patients with 58 major injuries to the bowel and mesentery due to blunt abdominal trauma were reviewed. The male to female ratio was 9: 1 and the average age was 32.51 years. There were 38 injuries to the small intestine including 1 duodenal injury, 13 colonic injuries and 6 isolated injuries to the mesentery. Out of 29 patients with intestinal perforation, free peritoneal air was present on plain abdominal and chest radiography in 23 patients. The commonest injury was a perforation at the antimesenteric border of the small bowel. Treatment consisted of laparotomy followed by simple closure of the perforation, resection and anastomosis and repair followed by protective colostomy for colonic perforations. 3 (7.56%) deaths were recorded, while 6 (15%) patients developed major complications.Conclusions: Bowel and mesenteric injuries may be significant and require immediate surgery or may be nonsignificant and permit nonsurgical treatment. Although early recognition of intestinal injuries from blunt abdominal trauma is difficult only by clinical assessment, nevertheless important to establish the right diagnosis due to its high infective potential. Intestinal perforations are often found accompanying other severe intra-peritoneal injuries which probably, are the determining factors in morbidity and mortality hence the main emphasis lying on early detection of the injuries and reducing the time from admission to the surgery thus playing a role in the reduction of mortality and morbidity associated with intestinal injuries following blunt trauma abdomen.

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Rupture of the bowel after blunt abdominal trauma: diagnosis with CT.

Cited by 163 publications

References 0 publications

Value of CT to predict surgically important bowel and/or mesenteric injury in blunt trauma: performance of a preliminary scoring system

Value of CT to predict surgically important bowel and/or mesenteric injury in blunt trauma: performance of a preliminary scoring system

Isolated Duodenal Rupture due to Go-Karting Accidents – Braking News

Evaluation of intestinal injuries from blunt abdominal trauma

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