Single-Contrast CT for Detecting Bowel Injuries in Penetrating Abdominopelvic Trauma

Abstract

Single-contrast CT can show bowel injuries in patients with penetrating abdominopelvic trauma with accuracy comparable with that reported for triple-contrast CT.

Diagnostic performance of CT and the use of GI contrast material for detection of hollow viscus injury after penetrating abdominal trauma. Experience from a level 1 Nordic trauma center

“…Certain authors have reported benefits of using a triple contrast protocol (oral, rectal, and i.v.) (6,9,11,12), while others have reported similar results for sensitivity and specificity of CT with intravenous contrast material only (8).…”

“…In our material, SWs were the most common cause of penetrating abdominal trauma and young men were most often involved, which is in accordance with studies from other European countries (15–17). However, in studies based on patient data from the United States, GSWs tend to be more prevalent (5,8,9).…”

“…The use of GI contrast material (rectal and/or oral contrast material) in addition to i.v. contrast material is somewhat varied between different trauma centers (7), and the literature is not unequivocal regarding the need for GI contrast material for the diagnosis of hollow viscus injury after penetrating trauma (6,8,9,12). Current practice at our institution is that the use of oral and/or rectal contrast should be considered in hemodynamically stable patients undergoing CT for penetrating trauma to the torso.…”

Imaging Ballistic Injuries

“…In stable and semistable patients, CT is the gold standard of evaluation. Although there are numerous CT scanning protocols proposed in the literature, 25 -34 by consensus the authors of this article advocate the protocol in Table 1. Irrespective of how an institution chooses to image ballistic trauma patients, the authors of this article strongly discourage attempting to modify or institute a new protocol “on the fly.” We believe that if there is no dedicated missile trauma protocol available, you should use your institutions standard imaging protocols under direct radiologist supervision with the addition of delayed imaging an additional arterial phase or CT cystography based on the “at the scanner” radiologist review of the initial imaging.…”

“…Additionally, the absence of a contrast leak does not exclude bowel injury and in our experience, high-density endoluminal contrast can limits one’s ability to discern the short segments of bowel hypoattenuation, which occur in missile trauma. A recent retrospective study 25 has shown that the use of only intravenous contrast has similar sensitivity and specificity to triple contrast technique.…”