Learning objectives
-To describe characteristics and advantages of CT in detection of mesenteric and bowel trauma
-To illustrate the CT features of bowel perforation spectrum
-To present CT signs of mesenteric lesions
-To evaluate pseudo-pneumoperitoneum as a pitfall in patients with suspected bowel trauma
Background
Traumatic bowel and mesenteric injuries (TBMI) are uncommon injuries with an incidence approaching 1% in recent series [1-5].
Despite this,
their clinical significance cannot be underestimated because it can be lethal if not detected and treated in a timely manner.
Clinical diagnosis is often a challenge because of the lack of specific findings in most patients and the presence of other associated lesions that may mask clinical manifestations,
in setting of loss of consciousness or head injury,
physical exam only 16% reliable in detecting abdominal...
Findings and procedure details
Technique
All CT examinations were performed with a 40 and 64-detector row CT scanner and all images were obtained in a craniocaudal direction.
The following parameters were used: reconstruction thickness,
1.25 mm; 120 kVp; pitch factor 0.98 ; and gantry rotation time,
0.4 second.
The use of oral contrast medium is controversial widely in the literature.
The risk of aspiration and delayed diagnosis with subsequent complications,
and especially the fact that the oral contrast does not provide additional information,
has led in at present,
in...
Conclusion
Early diagnosis of bowel and mesenteric injuries depends on tomographic evaluation,
therefore the radiologist must perform an active search for the signs described and must consider that the absence of pneumoperitoneum does not exclude intestinal trauma and that the presence of pneumoperitoneum is not always due to bowel injury.
Personal information
M.I. Carvajal MD
Department of Radiology.
Hospital Universitario San Vicente Fundación.
Universidad de Antioquia.
Medellín,
Colombia.
[email protected]
J.
Cano MD
Department of Radiology.
Hospital Universitario San Vicente Fundación.
Universidad de Antioquia.
Medellín,
Colombia.
A.
SuárezMD
Department of Radiology.
Hospital Universitario San Vicente Fundación.
Universidad de Antioquia.
Medellín,
Colombia.
J.
Aristizabal MD
Department of Radiology.
Hospital Universitario San Vicente Fundación.
Universidad de Antioquia.
Medellín,
Colombia.
References
Ekeh AP,
Saxe J,
Walusimbi M,
et al.
Diagnosis of blunt intestinal and mesenteric injury in the era of multidetector CT technologye are results better? J Trauma 2008;65:354-9.
Fakhry SM,
Watts DD,
Luchette FA.
Current diagnostic approaches lack sensitivity in the diagnosis of perforated blunt small bowel injury: analysis from 275,557 trauma admissions from the EAST multi- institutional HVI trial.
J Trauma 2003;54:295-306.
Watts DD,
Fakhry SM.
Incidence of hollow viscus injury in blunt trauma: an analysis from 275,557 trauma admissions from the East multi-institutional...