-To explain the CT protocol and discuss the need for oral contrast.
-To review the CT findings associated to bowel and mesenteric injury.
-Is it a pitfall? To make a revision of other signs that could be present (free air or free fluid),
explaining their different etiologies and when to suspect a bowel-mesenteric injury.
-To review the management of these patients.
The abdomen is the third most commonly injured region in trauma,
after the head and extremities.
Splenic injuries are the most common injury in blunt abdominal trauma,
followed by liver injuries and bowel/mesenteric injuries.
Bowel and mesenteric injuries are relatively uncommon,
being detected in 1-5% of patients with blunt abdominal trauma at laparotomy.
It may be a diagnostic challenge for the radiologist due to the subtle imaging findings,
presence of multiple concurrent injuries or injury of multiple bowel segments.
Delayed diagnosis of bowel and mesenteric...
Findings and procedure details
1- CT PROTOCOL
1.1 THE MOST COMMON SITUATION:
Intravenous nonionic contrast material = 300 mI/ml,
1,5-2 ml/kg administered intravenously at a rate of 3 ml/sec.
One sequence (PORTAL VENOUS PHASE) with a scanning delay of 70 sec.
after contrast injection.
NO oral contrast material.
In many institutions,
administration of oral contrast material has been routine.
many investigators from multiple institutions have shown that administration of oral contrast material is not necessary in the setting of blunt abdominal trauma.
- ADITIONAL TIME = delayed...
-Blunt abdominal trauma with bowel and mesenteric injury is uncommon,
but a timely diagnosis improves patient outcomes.
-MDCT is the technique of choice.
-The main goal is to distinguish significant bowel/mesenteric injuries (that require surgical intervention) from those non-significant (conservatory management).
-Familiarity with the direct and indirect signs of bowel and mesenteric injury in CT is essential.
1- Bates D,
Multidetector CT of Surgically Proven Blunt Bowel and Mesenteric Injury.
RadioGraphics 2017; 37:613–625
2- Brofman N,
Evaluation of bowel and mesenteric blunt trauma with multidetector CT.
2006; 26: 1119-1131
3- Vivek V,
Small-Bowel and Mesenteric Injuries in Blunt Trauma of the Abdomen.
Canadian Association of Radiologists Journal 64 (2013) 140e147
4- Brody JM,...