Segmental Bowel Hypoenhancement on CT Predicts Ischemic Mesenteric Laceration After Blunt Trauma

Boscak, Alexis R.; Bodanapally, Uttam K.; Elshourbagy, Tarek; Shanmuganathan, Kathirkamanathan

doi:10.2214/ajr.20.23108

Cited by 7 publications

(8 citation statements)

References 21 publications

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“…The mesenteric injury can be non-ischemic like mesenteric hematoma or ischemic which denotes avulsion of the mesentery from the segment of the bowel resulting in necrosis of the affected segment. A BHMT is the term used for the ischemic bowel injury with the devascularized bowel segment [8] . The bucket handle is the segment of the bowel detached from its mesentery.…”

Section: Discussionmentioning

confidence: 99%

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Bucket-handle mesenteric tear and traumatic abdominal wall hernia following bicycle handlebar injury in an adult: A ‘case report’

Bejiga¹

2023

International Journal of Surgery Case Reports

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Section: Discussionmentioning

confidence: 99%

“…A BHMT is a linear mesenteric laceration paralleling the bowel segment with the avulsion of the terminal vascular supply leading to ischemia and perforation if not intervened [7] , [8] . It is also called ischemic mesenteric injury.…”

Section: Introductionmentioning

confidence: 99%

Bucket-handle mesenteric tear and traumatic abdominal wall hernia following bicycle handlebar injury in an adult: A ‘case report’

Bejiga¹

2023

International Journal of Surgery Case Reports

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“…Small bowel perforation on CT is evident in the presence of direct signs such as bowel wall discontinuity, extraluminal air or presence of extraluminal contrast, or indirect CT sings: bowel wall thickening, abnormal bowel wall enhancement, presence of abdominal abscess formations [7,15,16,17] or mesenteric fat stranding and a moderate to large volume of unexplained intraperitoneal fluid in the absence of solid organ injury [19]. CT signs that correlated with mesenteric laceration are abdominal wall injury, mesenteric contusion, free fluid in peritoneal cavity, segmental bowel hypoenhancement, and bowel hyperenhancement adjacent to a hypoenhancing segment [20]. CT scan also indicates the location of bowel perforation.…”

Section: Discussionmentioning

confidence: 99%

Isolated jejunal perforation - hidden danger in blunt abdominal trauma

Doklestić

Vasin²,

Jovanović

et al. 2021

Srp Arh Celok Lek

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Introduction. Isolated jejunal perforation (IJP) without any associated injuries is rare in blunt abdominal trauma (BAT). It most commonly occurs in decelerating trauma. Diagnosis of traumatic intestinal perforation may be difficult in the first hours after injury so unrecognized ?missing? intestinal injuries incidences are as high as 24%. Unrecognized traumatic bowel perforation without adequate treatment leads to the intestinal leakage into the peritoneal cavity, making progress in secondary peritonitis and potentially lethal complications. Case outline. We presented the case of 43 years old women injured in road traffic accident. She was admitted to emergency surgery after diagnostic procedures according to the protocol for trauma. Initial examination, and body computed tomography (CT) revealed orthopedic injuries. Daily monitoring and follow-up examinations were done, she did not complain of any discomfort nor pain in the abdomen and there were no signs of abdominal injury. Two days after trauma, follow-up abdominal CT revealed highly suspected jejunum perforation, still with no signs of pneumoperitoneum. Laparotomy was performed and diagnosis of IJP was confirmed. Bowel perforation was surgically closed in two layers, followed by drainage of septic collections, abdominal saline lavage and primary abdominal closure. The patient was discharged on the seventh postoperative day without complications. Conclusion. In the case of BAT due to severe traumatic force in patient with nonspecific clinical signs of abdominal trauma on initial clinical and radiological examination, follow-up in a short period is necessary, to detect hidden jejunal perforation. Surgery is a life-saving for those patients and treatment of these injuries usually require simple operative procedures.

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“…4 ) can be decreased or increased depending on the pathological process affecting the bowel. Common observations include inflammatory hyperemia (increased contrast inflow), venous congestion (decreased contrast outflow), pathologically increased endothelial permeability (interstitial contrast accumulation), or a combination of these pathologies [ 27 ]. Increased enhancement may occur in a setting of hypoperfusion related to recent or ongoing blood loss or even contusion [ 8 ].…”

Section: Detecting the Abnormalities On Ctmentioning

confidence: 99%

“…The injury often presents with other sensitive signs, such as free fluid and mesenteric fat stranding. CT has a sensitivity and specificity of 72%–78% and 92%–95% for this injury, respectively [ 27 ].…”

Section: Detecting the Abnormalities On Ctmentioning

confidence: 99%

Radiologic Imaging of Traumatic Bowel and Mesenteric Injuries: A Comprehensive Up-to-Date Review

et al. 2023

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Diagnosing bowel and mesenteric trauma poses a significant challenge to radiologists. Although these injuries are relatively rare, immediate laparotomy may be indicated when they occur. Delayed diagnosis and treatment are associated with increased morbidity and mortality; therefore, timely and accurate management is essential. Additionally, employing strategies to differentiate between major injuries requiring surgical intervention and minor injuries considered manageable via non-operative management is important. Bowel and mesenteric injuries are among the most frequently overlooked injuries on trauma abdominal computed tomography (CT), with up to 40% of confirmed surgical bowel and mesenteric injuries not reported prior to operative treatment. This high percentage of falsely negative preoperative diagnoses may be due to several factors, including the relative rarity of these injuries, subtle and non-specific appearances on CT, and limited awareness of the injuries among radiologists. To improve the awareness and diagnosis of bowel and mesenteric injuries, this article provides an overview of the injuries most often encountered, imaging evaluation, CT appearances, and diagnostic pearls and pitfalls. Enhanced diagnostic imaging awareness will improve the preoperative diagnostic yield, which will save time, money, and lives.

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Segmental Bowel Hypoenhancement on CT Predicts Ischemic Mesenteric Laceration After Blunt Trauma

Cited by 7 publications

References 21 publications

Bucket-handle mesenteric tear and traumatic abdominal wall hernia following bicycle handlebar injury in an adult: A ‘case report’

Bucket-handle mesenteric tear and traumatic abdominal wall hernia following bicycle handlebar injury in an adult: A ‘case report’

Isolated jejunal perforation - hidden danger in blunt abdominal trauma

Radiologic Imaging of Traumatic Bowel and Mesenteric Injuries: A Comprehensive Up-to-Date Review

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