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Category: Volume 07 Issue 08 August 2019
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Title: Evaluation of blunt abdominal trauma with multi detector CT: special emphasis to bowel and mesenteric injury

Authors: Dr Shashank Saurav, Dr Amit Kumar Gupta

 DOI: https://dx.doi.org/10.18535/jmscr/v7i8.04

Abstract

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.

References

  1. Killeen KL, Shanmuganathan K, Poletti PA, Cooper C, Mirvis SE. Helical computed tomography of bowel and mesenteric injuries. J Trauma. 2001;51:26–36.
  2. Dauterive AH, Flancbaum L, Cox EF. Blunt intestinal trauma. A modern-day review. Ann Surg. 1985;201(2):198–203.
  3. Fakhry SM, Brownstein M, Watts DD, Baker CC, Oller D. Rela- tively short diagnostic delays (< 8 hours) produce morbidity and mortality in blunt small bowel injury: an analysis of time to opera- tive intervention in 198 patients from a multicenter experience. J Trauma. 2000;48:408–14.
  4. Malinoski DJ, Patel MS, Yakar DO, Green D, Qureshi F, Inaba K, et al. A diagnostic delay of 5 hours increases the risk of death after blunt hollow viscus injury. J Trauma. 2010;69:84–7.
  5. Bondia JM, Anderson SW, Rhea JT, Soto J. Imaging colo- rectal trauma using 64-MDCT technology. Emerg Radiol. 2009;16(6):433–40.
  6. Ekeh AP, Saxe J, Walusimbi M, Chorz KM, Woods RJ, Ander- son HL, et al. Diagnosis of blunt intestinal and mesenteric injury in the era of multidetector CT technology—are results better? J Trauma. 2008;65(2):354–9.
  7. Hines J, Rosenblat J, Duncan DR, Friedman B, Katz DS. Perfora- tion of the mesenteric small bowel: etiologies and CT findings. Emerg Radiol. 2013;20(2):155–61.
  8. Federle MP. Abdominal trauma. In: Gore R, Levine MS, editors. Textbook of gastrointestinal radiology (2 edn). Philadelphis: W.B. Saunders; 2000. p. 2255–61.
  9. Dolich MO, McKenney MG, Varela JE. 2,576 Ultrasounds for blunt abdominal trauma. J Trauma. 2001;50(1):108–12.
  10. Korner M, Krotz MM, Degenhart C, Pfeifer KJ, Reiser MF, Lin- senmaier U. Current role of emergency US in patients with major trauma. RadioGraphics. 2008;28:225–42.
  11. Scaglione M, de Lutio di Castelguidone E, Scialpi M, Merola S, Diettrich AI, Lombardo P, Romano L, Grassi R. Blunt trauma to the gastrointestinal tract and mesentery: is there a role for helical CT in the decision-making process? Eur J Radiol. 2004;50(1):67–73.
  12. Romano S, Scaglione M, Tortora G, Martino A, Di Pietto F, Romano L. Grassi R MDCT in blunt intestinal trauma. Eur J Radiol. 2006;59(3):359–66.
  13. Scaglione M, Romano L, Bocchini G, Sica G, Guida F, Pinto A, Grassi R. Multidetector computed tomography of pancre- atic, small bowel, and mesenteric traumas. Semin Roentgenol. 2012;47(4):362–70.
  14. Allen TL, Mueller MT, Bonk RT, Harker CP, Duffy OH, Stevens MH. Computed tomographic scanning without oral contrast solu- tion for blunt bowel and mesenteric injuries in abdominal trauma. J Trauma. 2004;56(2):314–22.
  15. Stuhlfaut JW, Soto JA, Lucey BC, Ulrich A, Rathlev NK, Burke PA, Hirsch EF. Blunt abdominal trauma: performance of CT with- out oral contrast material. Radiology. 2004;233(3):689–94.
  16. Lee CH, Haaland B, Earnest A, Tan CH. Use of positive oral contrast agents in abdominopelvic computed tomography for blunt abdominal injury: meta-analysis and systematic review. Eur Radiol. 2013;23(9):2513–21.
  17. Macari M, Balthazar EJ. CT of bowel wall thickening: sig- nificance and pitfalls of interpretation. AJR Am J Roentgenol. 2001;176(5):1105–16.
  18. Drasin TE, Anderson SW, Asandra A, Rhea JT, Soto JA. MDCT evaluation of blunt abdominal trauma: clinical significance of free intraperitoneal fluid in males with absence of identifiable injury. AJR. 2008;191:1821–6.
  19. Strouse PJ, Close BJ, Marshall KW, Cywes R. CT of bowel and mesenteric trauma in children. Radiographics. 1999;19:1237–50.
  20. Nghiem HV, Jeffrey RB Jr, Mindelzun RE. CT of blunt trauma to the bowel and mesentery. Semin Ultrasound CT MR. 1995;16:82–90.
  21. Levine CD, Gonzales RN, Wachsberg RH, Ghanekar D. CT find- ings of bowel and mesenteric injury. J Comput Assist Tomogr. 1997;21:974–9.
  22. Soto JA, Anderson SW. Multidetector CT of blunt abdominal trauma. Radiology. 2012;265(3):678–93.
  23. Atri M, Hanson JM, Grinblat L, Brofman N, Chughtai T, Tom- linson G. Surgically important bowel and/or mesenteric injury in blunt trauma: accuracy of multidetector CT for evaluation. Radiol- ogy. 2008;249:524–33.
  24. Roman E, Silva YJ, Lucas C. Management of blunt duodenal injury. Surg Gynecol Obstet. 1971;132:7–14.
  25. Brofman N, Atri M, Hanson JM, Grinblat L, Chughtai T, Brenne- man F. Evaluation of bowel and mesenteric blunt trauma with multidetector CT. Radiographics. 2006;26(4):1119–31.
  26. Breen DJ, Janzen DL, Zwirewich CV, Nagy AG. Blunt bowel and mesenteric injury: diagnostic performance of CT signs. J Comput Assist Tomogr. 1997;21:706–12.
  27. Castrillon GA, Soto JA. Multidetector computed tomogra- phy of penetrating abdominal trauma. Semin Roentgenol. 2012;47(4):371–6.
  28. Le Bedis CA, Anderson SW, Soto JA. CT Imaging of blunt traumatic bowel and mesenteric injuries. Radiol Clin N Am. 2012;50:123–36.
  29. Cho HS, Woo JY, Hong H-S, Park MH, Ha H II, Yang I, et al. Multidetector CT findings of bowel transection in blunt abdominal trauma. Korean J Radiol. 2014;14(4):607–15.
  30. Malhotra AK, Fabian TC, Katsis SB. Blunt bowel and mesenteric injuries: the role of screening computed tomography. J Trauma. 2000;48:991.
  31. Wisner DH, Chun Y, Blaisdell FW. Blunt intestinal injury. Keys to diagnosis and management. Arch Surg. 1990;125(10): 1319–22 (discussion 1322-1323).
  32. Faget C, Taourel P, Charbit J, Ruyer A, Alili C, et al. Value of CT to predict surgically important bowel and/or mesenteric injury in blunt trauma: performance of a preliminary scoring system. Eur Radiol. 2015;25:3620–8.
  33. Mirvis SE, Shanmuganathan K, Erb R. Diffuse small-bowel ischemia in hypotensive adults after blunt trauma (shock bowel): CT findings and clinical significance. AJR AM J Roentgenol. 2009;192:W230–5.
  34. Udekwu PO, Gurkin B, Oller DW. The use of computed tomog- raphy in blunt abdominal injuries. Am Surg. 1996;62(1):56–9.
  35. Khan I, Bew D, Elias DA, Lewis D, Meacock LM. Mechanisms of injury and CT findings in bowel and mesenteric trauma. Clin Radiol. 2014;69(6):639–47.
  36. Yu J, Fulcher AS, Turner MA, Cockrell C, Halvorsen RA. Blunt bowel and mesenteric injury: MDCT diagnosis. Abdom Imaging. 2011;36:50–61.

Corresponding Author

Dr Shashank Saurav

JR Radio-Diagnosis