CT of Blunt Trauma Bowel and Mesenteric Injury: Typical Findings and Pitfalls in Diagnosis

Abstract

Detection of bowel and mesenteric injury can be challenging in patients after blunt abdominal trauma. Early diagnosis and treatment are critical to decrease patient morbidity and mortality. Computed tomography (CT) has become the primary modality for the imaging of these patients. Signs of bowel perforation such as free air and contrast material are virtually pathognomonic. Bowel-wall thickening, free fluid, and mesenteric infiltration may be seen with this type of injury and partial thickness injuries. The authors present and discuss the range of CT findings seen with bowel and mesenteric injuries. Examples of observation and interpretation errors are also provided to highlight pitfalls encountered in the evaluation of abdominopelvic CT scans in patients after blunt trauma.

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

“…2b, 5c, 5d) (13,16). The diagnostic performance of this sign for site localization has never been reported previously, though it has been described as a sign of bowel injury necessitating urgent laparotomy to prevent peritonitis secondary to the full-thickness injury (16).…”

“…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- …”

“…The results of predictive value of CT in detecting site of GIT injuries in nontraumatic cases cannot be directly extrapolated to traumatic GIT perforation, as appendiceal and gastroduodenal perforations secondary to peptic ulcer disease are common in nontraumatic cases, while small bowel injury is the most common site of injury in trauma (19,20,22,24). Secondly, polytrauma patients have multiple sites of GIT injuries and other injuries which can affect diagnostic performance of MDCT in detecting sites of traumatic GIT perforation (13,23,32).…”

Evaluation of three phases computed tomography scan findings in blunt abdominal trauma

“…1,2 Computed Tomography (CT) scan is as a noninvasive and available method to accurately identify injury to internal organs of the abdomen and pelvis in patients with blunt abdominal trauma in a limited time. 8 CT scan is a quick and accurate tool to diagnose abdominal organs injury, and is also used to detect retroperitoneal and abdominal wall injury. The use of CT scan is also a helpful method to diagnose fractures of hip, spine and chest.…”

Small Bowel Perforations: What the Radiologist Needs to Know

“…3,4 However, perforation of the small bowel is not a common cause of acute abdomen and can have a traumatic or nontraumatic etiology. [2][3][4][5][6][7][8] The traumatic perforations of small bowel are more frequent than nontraumatic ones. [5][6][7][9][10][11][12][13] In particular, small bowel traumatic perforation is the third in frequency among abdominal traumatic perforations following liver and spleen ones; these lesions are rarely isolated.…”