Multi Detector Computed Tomography in the Diagnosis of Bowel Injury

Abstract

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.

Diagnostic Accuracy of Multidetector Computed Tomography in Evaluation of Retroperitoneal Traumatic Injuries and Retroperitoneal Hemorrhage

“…In the current study the retroperitoneal bowel injury reported in two patient (6.67%); one of them had duodenal perforation and the other had duodenal contusion, these results not agreed with Magu et al, (2012) [20] they reported on their study on 32 cases that duodenal injuries seen in 8 cases (25%) and retroperitoneal bowel injuries found in 3 cases (9.4%).…”

Multi-slice computed tomography for diagnosis of combined thoracoabdominal injury

“…CT signs of bowel injury consists of pneumoperitoneum, discontinuity of hollow viscus wall, oral contrast extravasation, gas bubbles close to the injured hollow viscus, thickened bowel wall (>4 mm), bowel wall hematoma, intraperitoneal fluid of unknown source, and patchy bowel enhancement. 8,9 Generally, bowel wall discontinuity and oral contrast extravasation are highly specific signs for the diagnosis of bowel perforation, however these signs were not seen in our series. Pneumoperitoneum, thickened bowel wall and bowel wall hematoma are signs strongly suggestive of bowel injury, but the following conditions causing pneumoperitoneum should be precluded: pneumoperitoneum caused by abdominal puncture or lavage, gas in the pleural cavity to the peritoneal cavity, gas from the birth canal.…”

Non operative management of abdominal trauma – a 10 years review

“…Presence of fluid without solid organ injury is a significant marker of mesenteric or bowel injury [17]. Usefulness of CT in bowel injuries remains controversial [18]. …”