Blunt trauma to the gastrointestinal tract and mesentery: is there a role for helical CT in the decision-making process?

Scaglione, Mariano; Castelguidone, Elisabetta de Lutio di; Scialpi, Michele; Merola, Stefanella; A, Diettrich; Lombardo, Patrizia; Romano, Luigia; Grassi, Roberto

doi:10.1016/j.ejrad.2003.11.016

Cited by 81 publications

(70 citation statements)

References 24 publications

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“…When only these signs were present correlation with clinical findings is necessary. Scaglione et al [11] found CT findings considered suggestive of bowel injury in 8/13 patients. These consisted of: pneumoperitoneum (six), gas bubbles close to the injured hollow viscus (three), thickened (>4-5 mm) bowel wall (five), bowel wall hematoma (three), intraperitoneal fluid of unknown source (three).…”

Section: Discussionmentioning

confidence: 98%

“…While, CT findings considered suggestive of bowel injury consisted of: pneumoperitoneum, gas bubbles close to the injured hollow viscus, thickened (>4-5 mm) bowel wall, bowel wall hematoma, intraperitoneal fluid of unknown source [11].…”

Section: Discussionmentioning

confidence: 99%

“…In the study by Scaglione et al [11] there were 13 surgically proven cases of bowel injury. These occured in the duodenum (03 cases), ileum (02 cases), jejunum (02 cases) colon (03 cases) and stomach (03 cases).…”

Section: Discussionmentioning

confidence: 99%

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Multi Detector Computed Tomography in the Diagnosis of Bowel Injury

2012

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Bowel Injuries are uncommonly associated with traumatic abdominal injuries. However, they are associated with significant morbidity and mortality and require operative intervention unlike solid organ injuries. Hence, early diagnosis is of paramount importance. Computed tomographic (CT) scan is a well-established and highly accurate imaging modality for the detection of solid organ injury after blunt abdominal trauma. However, its role in diagnosing hollow viscus injury remains controversial. The aim of our study was to analyze the accuracy of multidetector CT (MDCT) in the diagnosis of bowel injury. Imaging features of surgically proven cases of bowel injury were identified over 8-year period (i.e., from January 2003 to December 2010) and were retrospectively analyzed. There were 32 patients with age range of 3-90 years. There was only one female. Sensitivity of various CT signs specific to bowel injury (i.e., extravasation of contrast and discontinuity of bowel wall) was 15.62, and 28.12%, respectively. While that of signs suggestive of bowel injury were pneumoperitoneum, 62.5%; gas in the vicinity, 40.62%; bowel wall hematoma, 21.87%; bowel wall thickening, 75%; ascites, 78.12%; mesenteric hematoma, 46.87%; and mesenteric stranding, 40.62%. Based on the major and minor signs, a diagnosis of bowel injury could be made in all patients except one. The minor signs showed a higher sensitivity than the major signs. Hence, we recommend that multidetector CT should be used as the modality of choice in case of patients with suspected bowel injury. We also suggest that the minor signs should be given as much importance as the major signs.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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Multi Detector Computed Tomography in the Diagnosis of Bowel Injury

2012

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“…The 'classic' clinical triad of abdominal pain, rigidity and absent bowel sounds is only seen in less than onethird of all patients [5]. The delayed diagnosis of mesenteric injury is known to be associated with significant morbidity and even mortality [6].…”

Section: Discussionmentioning

confidence: 99%

Missed mesenteric injury in blunt abdominal trauma: A potentially lethal error

Kong¹,

Burce²,

Oosthuizen³

et al. 2013

IJCRI

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Introduction: Mesenteric injury following blunt abdominal trauma is uncommon. Delay in diagnosis is unfortunately common due to its subtle clinical presentation and is associated with significant morbidity and mortality. Case Report: We present a case of a 35yearold male who was discharged home with a missed mesenteric injury. The initial computed tomography scan of the abdomen and pelvis was normal. He represented acutely with small bowel infarction. Conclusion: Although computed tomography is the current gold standard of investigation, a very small proportion of injuries that require surgical intervention will invariably be missed. This case highlights several pitfalls in evaluation of these patients. Clinicians must always be vigilant of such injury despite normal radiological studies. A sufficient period of observation post injury should be considered in circumstances where

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“…Various CT signs of GIT and mesenteric injuries have been described such as bowel wall discontinuity, extraluminal air (either free or perivisceral), bowel wall thickening, abnormal bowel wall enhancement and intramural air, while mesenteric signs include mesenteric infiltration, active vascular contrast extravasation, beading, and abrupt termination of mesenteric vessels. These signs have reportedly variable incidences, sensitivities, and specificities; but if present, can lead prompt laparotomy and surgical exploration of the GIT to look for direct evidence of injury (12)(13)(14)(15)(16).MDCT with its capabilities of fast scanning, thin-section acquisition, and multiplanar reformatting has greatly enhanced the potential for detecting direct evidence of bowel in- …”

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confidence: 99%

Can multidetector CT detect the site of gastrointestinal tract injury in trauma? – A retrospective study

Kumar¹,

Gamanagatti²,

Das³

et al. 2017

Diagn Interv Radiol

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T raumatic gastrointestinal tract (GIT) injuries are uncommon, representing less than 10% of all injuries in trauma patients (1), with a higher incidence in penetrating rather than blunt trauma (2). Small bowel is the most common site of alimentary tract injury in trauma followed by colorectal injuries, while gastroduodenal injuries comprise less than 2% of all injuries in trauma (3). In the current scenario of preferential nonoperative management in trauma, detection of GIT injury remains an important indication for urgent laparotomy as delayed diagnosis and surgery are associated with high morbidity and mortality (4). Also the type of operative management, prognosis, and outcome vary according to the number and site of GIT injuries (5).Multidetector computed tomography (MDCT) is a proven diagnostic modality for detection of traumatic GIT injuries with a reported sensitivity of 70%-95% and specificity of 92%-100% (6-11). Various CT signs of GIT and mesenteric injuries have been described such as bowel wall discontinuity, extraluminal air (either free or perivisceral), bowel wall thickening, abnormal bowel wall enhancement and intramural air, while mesenteric signs include mesenteric infiltration, active vascular contrast extravasation, beading, and abrupt termination of mesenteric vessels. These signs have reportedly variable incidences, sensitivities, and specificities; but if present, can lead prompt laparotomy and surgical exploration of the GIT to look for direct evidence of injury (12)(13)(14)(15)(16).MDCT with its capabilities of fast scanning, thin-section acquisition, and multiplanar reformatting has greatly enhanced the potential for detecting direct evidence of bowel in- 29From the Departments of Radiology (A.K.  dratinkumar@gmail.com; A.P., S.G., R.D., S.P.) and Surgery (A.G., S.K.), Jai Prakash Narayana Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India. E M E R G E N C Y R A D I O LO G Y O R I G I N A L A R T I C L E PURPOSEWe aimed to assess the performance of computed tomography (CT) in localizing site of traumatic gastrointestinal tract (GIT) injury and determine the diagnostic value of CT signs in site localization. METHODSCT scans of 97 patients with surgically proven GIT or mesenteric injuries were retrospectively reviewed by radiologists blinded to surgical findings. Diagnosis of either GIT or mesenteric injuries was made. In patients with GIT injuries, site of injury and presence of CT signs such as focal bowel wall hyperenhancement, hypoenhancement, wall discontinuity, wall thickening, extramural air, intramural air, perivisceral infiltration, and active vascular contrast leak were evaluated. RESULTSOut of 97 patients, 90 had GIT injuries (70 single site injuries and 20 multiple site injuries) and seven had isolated mesenteric injury. The overall concordance between CT and operative findings for exact site localization was 67.8% (61/90), partial concordance rate was 11.1% (10/90), and discordance rate was 21.1% (19/90). For single site localization, concordance...

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Blunt trauma to the gastrointestinal tract and mesentery: is there a role for helical CT in the decision-making process?

Cited by 81 publications

References 24 publications

Multi Detector Computed Tomography in the Diagnosis of Bowel Injury

Multi Detector Computed Tomography in the Diagnosis of Bowel Injury

Missed mesenteric injury in blunt abdominal trauma: A potentially lethal error

Can multidetector CT detect the site of gastrointestinal tract injury in trauma? – A retrospective study

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