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

Faget, Claire; Taourel, Patrice; Charbit, Jonathan; Ruyer, Alban; Alili, Chakib; Molinari, Nicolas; Millet, Ingrid

doi:10.1007/s00330-015-3771-7

Cited by 42 publications

(57 citation statements)

References 27 publications

(43 reference statements)

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“…Reduced bowel-wall enhancement may represent an ischemic bowel due to the rupture of supplied arteries or arterial occlusions (12). In our study, this feature had a sensitivity of 15%, which was lower than that reported by Faget et al (8), and higher than the result reported by Atri et al (7); it also had specificity of 100%, which was in line with findings that reported by these authors.…”

Section: Discussionsupporting

confidence: 90%

“…Bowel-wall rupture was considered as a direct finding of blunt bowel injury, and active extravasation suggested that an active bleeding condition has high specificity of 100% and 98.15% and low sensitivity of 28.57% and 28.57%, respectively. Our result was comparable to those reported in the previous studies, which confirmed that these characteristics are not highly sensitive (7,8,11). Since bowel-wall rupture frequently occurs at the antimesenteric side of bowel loops, it could be misdiagnosed on a MDCT scan if its size is small (16).…”

Section: Discussionsupporting

confidence: 90%

“…Since bowel-wall rupture frequently occurs at the antimesenteric side of bowel loops, it could be misdiagnosed on a MDCT scan if its size is small (16). Similarly, a small vessel tear could be occulted by mesenteric hematoma (8). Nonetheless, a finding of active extravasation should be taken into consideration as an indication for simultaneous surgery (4,5).…”

Section: Discussionmentioning

confidence: 99%

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

Duc

Hung

et al. 2020

Electron J Gen Med

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Background: Bowel and mesenteric injuries have high morbidity and mortality rates in the trauma group due to non-specific symptoms and are often obscured in the context of multiple traumas, contributing to an increased risk of peritonitis and sepsis. The purpose of this research was to assess the diagnostic accuracy of 16-slice multidetector computed tomography (MDCT) findings in the diagnosis of bowel and mesenteric injuries accompanied by the association of these findings with the treatment strategy. Methods: A retrospective study was performed on 86 blunt-abdominal-trauma patients, hospitalized at the emergency department of our institution from June 2018 to July 2019 (75 men and 11 women aged 4-76 years old with a median age of 40.88), who had 16-slice MDCT diagnosis of blunt bowel and mesenteric injuries and were treated by nonsurgical and surgical treatment. Ethical clearance was taken from the institute ethics committee with waiver of consent. Results: The specificity of bowel-wall rupture, active extravasation, and reduced bowel-wall enhancement were 100%, 98.15%, and 100%, respectively. Pneumoperitoneum had the highest sensitivity of 83.33%. Bowel-wall rupture, Janus signs, pneumoperitoneum, and mesenteric stranding were significantly correlated with surgical results. The existence of these results improved the likelihood of 7-, 6-, 29-and 3-fold surgical treatment, respectively. Inter-observer consensus was very strong for bowel-wall rupture, active extravasation, bowel hematoma, and pneumoperitoneum. Conclusion: Bowel-wall rupture was the definite sign of bowel injury and its connection with surgical treatment was important. Pneumoperitoneum was not a specific indication of blunt bowel injury; but when this is detected, emergency intervention should be suggested.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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

Duc

Hung

et al. 2020

Electron J Gen Med

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“…Hay marcadores radiológicos como aire libre en cavidad abdominalque sugiere fuertemente lesión intestinal, otros marcadores también puede indicar lesión intestinal aguda como líquido libre intraperitoneal o engrosamiento de pared intestinal (5,6) . De ahí que en presencia de líquido libre intraperitoneal en ausencia de lesión de órgano solido es uno de los marcadores radiológicos más ampliamente estudiados para una posible lesión intestinal, si bien líquido libre aislado en pacientes asintomáticos podrían ser manejados de forma segura y no quirúrgica (7) .…”

Section: Discussionunclassified

Management of intestinal injury by laparoscopy

Brunaga

Oviedo

González

2018

Rev. Nac. (Itauguá)

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Las lesiones intestinales por trauma contuso o cerrado en abdomen son menos frecuentes; sin embargo, representan la tercera víscera más lesionada por esta causa Para arribar al diagnóstico de lesiones intestinal en forma temprana es difícil y cualquier demora del mismo se asocia con alta morbimortalidad El estudio complementario por excelenciapara su diagnóstico en paciente estable es la tomografía. Presentamos un casode unapecienta de sexo femenina de 56 años de edad que acude al servicio de urgencia por cuadro deantecedente de accidente vehicular que en base a la búsqueda de criterios predictores de lesiones intestinal y mesentérico se indicócirugía de urgenciaarribando a un diagnóstico y tratamiento precoz de lesión intestinal en trauma contuso por vía laparoscópica en forma temprana.

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“…Bowel walls were considered thick if they were greater than 3 mm for the small bowel and 5 mm for the colon [23,25,31]. Bowel wall thickening was considered as focal if it was less than 10 cm in length, and non-focal if it was longer than 10 cm [32]. However, isolated mesenteric vascular injury can cause localized or segmental bowel wall thickening, which may indicate bowel ischemia.…”

Section: Bowel Wall Thickening and Abnormal Enhancementmentioning

confidence: 99%

Evaluation of bowel and mesenteric blunt trauma with multidetector CT: spectrum of signs beyond pneumoperitoneum

2019

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Multidetector computed tomography (CT) is the primary imaging modality for diagnosing bowel and mesenteric blunt trauma. Pneumoperitoneum is the commonly observed for imaging sign among radiologists. There are, however, other CT findings with different clinical significances. The aim of this article is to heighten radiologist awareness regarding the diagnostic capability of CT in bowel and mesenteric blunt trauma, and to illuminate potential pitfalls to be avoided in this patient population. This guide was developed to enhance the knowledge and awareness of non-expert radiologists that may be less aware of the nuances of abdominal CT imaging in a blunt trauma setting. This enhanced knowledge and awareness will improve patient diagnosis, treatment, and outcomes.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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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

Cited by 42 publications

References 27 publications

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

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

Management of intestinal injury by laparoscopy

Evaluation of bowel and mesenteric blunt trauma with multidetector CT: spectrum of signs beyond pneumoperitoneum

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