Bowel and mesenteric injury in blunt trauma: diagnostic efficiency of and importance of experience in using multidedector computed tomography

Polat, Ahmet Veysel; Aydin, Recep; Nural, Mehmet Selim; Gul, Selim Baris; Polat, Ayfer Kamalı; Aslan, Kerim

doi:10.5505/tjtes.2014.52959

Cited by 6 publications

(6 citation statements)

References 18 publications

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“…CT is the gold standard examination for SOI and for identifying the source of bleeding with more than 90% accuracy, having an essential role in follow up also (23). In case of HOI and mesenteric injury, in the first 6 hours from the incident, CT can miss the injury in 5,9 -14.8% of cases (24,25,26). Free intraperitoneal fluid without SOI is the most common indirect sign present in more than 90% of bowel injuries (sensibility of over 90% but specificity below 33%) (23,24).…”

Section: Discussionmentioning

confidence: 99%

The Role of Laparoscopy in Abdominal Trauma: A 10-Year Review

Nicolau¹,

Craciun²,

Vasile³

et al. 2019

chr

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Laparoscopia este acceptată în plăgile abdominale (PA), dar în contuziile abdominale (CA) utilizarea ei este controversată. Lucrarea noastra evalueaza utilizarea laparoscopiei diagnostice (LD) si al laparoscopiei terapeutice (LT) in traumatismele abdominale în perioada Decembrie 2006-Ianuarie 2016. S-au analizat indicaţiile, leziunile, LT, conversiile, complicaţiile, durata spitalizarii. LD s-a efectuat la 49 de pacienţi stabili hemodinamic, 42 de barbaţi şi 7 femei cu varsta medie 36,6 ±13,3 ani. Au fost 20 PA SI 29 CA. Principalele indicaţii au fost: diagnosticul penetraţiei în PA, suspiciunea de leziune de organ cavitar sau diafragm, hemoragia activă în leziunile viscerale din CA. Preoperator, 11/48 ecografii abdominale şi 4/28 examene CT au fost fals negative. Dintre cele 20 LD pentru PA, 3 au fost negative si 4 nonterapetice. Au fost 4 LT şi 7 conversii. La cele 29 de CA, principalele leziuni au fost: perforaţie de organ cavitar 9, dilacerări mezenterice 6, leziuni splenice 2, leziuni de diafragm 2. Au fost 10 LT şi 9 conversii si 14 LT: enterorafii şi enterectomii 6 (5 asistate), frenorafii 4, colecistectomie 1, hemostaze 4. Durata intervenţiilor şi spitalizarea postoperatorie au fost mai mari în conversii. Au fost 6 complicaţii şi 3 decese. Nu au fost leziuni omise. O laparotomie nenecesară s-a evitat în 18/49 cazuri (36,73%). În cazuri selectate de PA şi CA cu diagnostic clinic şi imagistic echivoc, laparoscopia este o modalitate diagnostica utilă, cu potenţial terapeutic, care reduce laparotomiile nenecesare, perioada de spitalizare şi complicaţiile.

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Section: Discussionmentioning

confidence: 99%

The Role of Laparoscopy in Abdominal Trauma: A 10-Year Review

Nicolau¹,

Craciun²,

Vasile³

et al. 2019

chr

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“…S MALL BOWEL AND MESENTERIC INJURIES are present in 1 to 5 per cent of patients with blunt abdominal trauma. [1][2][3][4] CT is used widely and may detect small bowel and mesenteric injury; however, its sensitivity and specificity in predicting the need for operative intervention is imperfect. 2,[5][6][7] Mesenteric hematoma is one of the possible CT findings after blunt abdominal trauma that may be indicative of an underlying mesenteric injury, and subsequently possible bowel ischemia or infarction from disruption of blood flow.…”

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confidence: 99%

“…5,8,10 Another difficulty when encountering mesenteric hematomas on CT is determining whether the hemorrhage is ongoing or stopped, and therefore to differentiate those patients requiring surgical treatment from those that can be managed conservatively. 3,7 Delayed diagnosis and treatment of a mesenteric injury can lead to significant morbidity and mortality from complications related to bowel ischemia resulting from hemorrhage of injured mesenteric vessels. 2,3,6,7,[11][12][13][14] On the other hand, performing surgical procedures for injuries that could have been managed nonoperatively can result in negative laparotomies with the potential for surgery-related morbidity and mortality.…”

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confidence: 99%

“…3,7 Delayed diagnosis and treatment of a mesenteric injury can lead to significant morbidity and mortality from complications related to bowel ischemia resulting from hemorrhage of injured mesenteric vessels. 2,3,6,7,[11][12][13][14] On the other hand, performing surgical procedures for injuries that could have been managed nonoperatively can result in negative laparotomies with the potential for surgery-related morbidity and mortality. 6,[14][15][16][17] Despite the low incidence of this radiographic finding, it can lead to deleterious complications if left untreated, or if performing unnecessary surgery.…”

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confidence: 99%

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Mesenteric Hematoma: Is there a Role for Selective Management?

Corzo

Murdock

Alarcon

et al. 2016

The American Surgeon

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Mesenteric hematomas may present as a radiologic finding after blunt abdominal trauma that may be associated with surgically significant mesenteric and/or bowel injury. The question of whether to operate or not to operate on patients with mesenteric hematoma remains a topic of debate, especially with the improved imaging technology. This study sought to identify clinical and radiological characteristics for patient selection for operative management (OM) of mesenteric hematoma. A retrospective review of 33 adults with blunt abdominal trauma and mesenteric hematoma on CT scan (2009–2012) was performed. Patients with other intra-abdominal injuries, penetrating trauma, isolated gastric hematoma, contrast extravasation, extraluminal air, and Glasgow Coma Scale < 14 were excluded. Patients requiring surgical treatment within 24 hours of admission were compared with those who did not using chi-squared test, Fisher's exact test, and t test. Parameters included age, gender, race, Glasgow Coma Scale, vital signs, pain, tenderness, ecchymosis, Injury Severity Score, length of stay, and inhospital mortality. Logistic regression was used to determine positive associations with OM. Of the 33 patients, 19 underwent OM and 14 did not. Both groups were similar at baseline. Regression analysis revealed association for pain [odds ratio (OR) = 9.6, confidence interval (CI) = 1.8–49.9, P < 0.01], tenderness (OR = 32, CI = 4.6–222.2, P < 0.01), and free fluid (OR = 10.3, CI = 1.8–60, P < 0.01) with need for operative intervention. Nonoperative management patients had 100 per cent success rate. Of the OM patients, 100 per cent underwent therapeutic laparotomies. Findings of mesenteric hematoma on CT scan in examinable patients with no abdominal pain, tenderness, or free fluid predict successful nonoperative management.

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“…CT is the standard imaging modality used to diagnose bowel and mesenteric injuries in hemodynamically stable patients with blunt abdominal trauma [1,3]. CT findings consistent with major mesenteric injuries that indicate the need for urgent surgery include active blood extravasation, mesenteric avulsion resulting in intestinal ischemia, and full-thickness tear of the mesentery [1].…”

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confidence: 99%

Delayed Mesenteric Hematoma of the Sigmoid Colon Following Blunt Abdominal Trauma

2017

Medical &Amp; Clinical Research

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A 25-year-old Hispanic male was transferred to our level I trauma center after being ejected 40 feet from a motor vehicle crash. Once stabilized in the trauma bay, a computed tomography (CT) scan of the abdomen/pelvis with IV contrast revealed two AAST Organ Injury Scale grade III liver lacerations without contrast extravasation, bilateral pulmonary contusions, right posterior non-displaced fourth rib fracture, non-displaced right scapular body fracture, and bilateral anterior and posterior pelvic fractures [Figures 1–2]. A non-operative approach to the hepatic lacerations was chosen and the patient underwent closed reduction and percutaneous pinning of his posterior pelvic fractures as well as anterior external fixation of his bilateral pubic rami fractures.

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Bowel and mesenteric injury in blunt trauma: diagnostic efficiency of and importance of experience in using multidedector computed tomography

Abstract: BACKGROUND:The purpose of this study was to investigate the diagnostic efficiency of multidetector computed tomography (MDCT) in the detection of blunt bowel and mesenteric injuries (BBMI), and the role of different experience levels in using MDCT.

Cited by 6 publications

References 18 publications

The Role of Laparoscopy in Abdominal Trauma: A 10-Year Review

The Role of Laparoscopy in Abdominal Trauma: A 10-Year Review

Mesenteric Hematoma: Is there a Role for Selective Management?

Delayed Mesenteric Hematoma of the Sigmoid Colon Following Blunt Abdominal Trauma

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