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Multi-detector CT of blunt mesenteric injuries: usefulness of imaging findings for predicting surgically significant bowel injuries

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Abstract

Purpose

The objective of this study is to determine which imaging features of blunt mesenteric injuries best predict the presence of a bowel injury requiring surgical correction.

Methods

The radiology archives at a Level 1 trauma center were searched over a 5-year period to identify patients with mesenteric injuries seen on admission 64 slice MDCT. Two emergency radiologists, blinded to clinical and surgical outcomes, retrospectively recorded mesenteric injury size, the presence/absence of active mesenteric bleeding, bowel wall thickening, adjacent interloop free fluid, extraluminal gas, mesenteric vessel termination, mesenteric vessel “beading”, focal bowel wall defect, and bowel wall perfusion abnormality. Based on all of the imaging findings, the radiologists were asked to determine if they thought the patient had a surgical bowel injury.

Results

One hundred twenty-six patients with mesenteric injuries were identified. Eighteen patients underwent laparotomy confirming the presence of bowel injury in 15. The remaining patients were successfully managed non-operatively. There was no statistically significant difference in size of mesenteric injury for surgical vs. non-surgical bowel injuries. Active bleeding, adjacent interloop free fluid, and bowel wall perfusion defects were strong predictors of the presence of a surgically significant bowel injury (p < 0.001, 0.002, and 0.020, respectively). The overall accuracy, sensitivity, specificity, PPV, and NPV of 64-MDCT were 73.8%, 80%, 73.0%, 28.6%, and 96.4%, respectively.

Conclusions

Mesenteric active bleeding, adjacent interloop free fluid and bowel wall perfusion defects are associated with surgically significant bowel injuries. The diagnosis of surgical bowel injuries remains challenging despite 64-slice MDCT technology.

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References

  1. Atri M, Hanson JM, Grinblat L, et al. (2008) Surgically important bowel and/or mesenteric injury in blunt trauma: accuracy of multidetector CT for evaluation. Radiology 249:524–533

    Article  PubMed  Google Scholar 

  2. Holmes JF, Offerman SR, Chang CH, et al. (2004) Performance of helical computed tomography without oral contrast for the detection of gastrointestinal injuries. Ann Emerg Med 43:120–128

    Article  PubMed  Google Scholar 

  3. Watts DD, Fakhry SM, Group EM-IHVIR (2003) Incidence of hollow viscus injury in blunt trauma: an analysis from 275,557 trauma admissions from the EAST multi-institutional trial. J Trauma 54:289–294

    Article  PubMed  Google Scholar 

  4. Killeen KL, Shanmuganathan K, Poletti PA, Cooper C, Mirvis SE (2001) Helical computed tomography of bowel and mesenteric injuries. J Trauma 51:26–36

    Article  CAS  PubMed  Google Scholar 

  5. Butela ST, Federle MP, Chang PJ, et al. (2001) Performance of CT in detection of bowel injury. AJR Am J Roentgenol 176:129–135

    Article  CAS  PubMed  Google Scholar 

  6. Scaglione M, de Lutio di Castelguidone E, Scialpi M, et al. (2004) Blunt trauma to the gastrointestinal tract and mesentery: is there a role for helical CT in the decision-making process? Eur J Radiol 50:67–73

    Article  PubMed  Google Scholar 

  7. Brofman N, Atri M, Hanson JM, et al. (2006) Evaluation of bowel and mesenteric blunt trauma with multidetector CT. Radiographics 26:1119–1131

    Article  PubMed  Google Scholar 

  8. Fakhry SM, Brownstein M, Watts DD, Baker CC, Oller D (2000) Relatively short diagnostic delays (<8 h) produce morbidity and mortality in blunt small bowel injury: an analysis of time to operative intervention in 198 patients from a multicenter experience. J Trauma 48:408–414 (discussion 414–405)

    Article  CAS  PubMed  Google Scholar 

  9. Malinoski DJ, Patel MS, Yakar DO, et al. (2010) A diagnostic delay of 5 hours increases the risk of death after blunt hollow viscus injury. J Trauma 69:84–87

    Article  PubMed  Google Scholar 

  10. Rizzo MJ, Federle MP, Griffiths BG (1989) Bowel and mesenteric injury following blunt abdominal trauma: evaluation with CT. Radiology 173:143–148

    Article  CAS  PubMed  Google Scholar 

  11. Robbs JV, Moore SW, Pillay SP (1980) Blunt abdominal trauma with jejunal injury: a review. J Trauma 20:308–311

    CAS  PubMed  Google Scholar 

  12. Meredith JW, Ditesheim JA, Stonehouse S, Wolfman N (1992) Computed tomography and diagnostic peritoneal lavage. Complementary roles in blunt trauma. Am Surg 58:44–48

    CAS  PubMed  Google Scholar 

  13. Peitzman AB, Makaroun MS, Slasky BS, Ritter P (1986) Prospective study of computed tomography in initial management of blunt abdominal trauma. J Trauma 26:585–592

    Article  CAS  PubMed  Google Scholar 

  14. Janzen DL, Zwirewich CV, Breen DJ, Nagy A (1998) Diagnostic accuracy of helical CT for detection of BMI. Clin Radiol 53:193–197

    Article  CAS  PubMed  Google Scholar 

  15. Mirvis SE, Gens DR, Shanmuganathan K (1992) Rupture of the bowel after blunt abdominal trauma: diagnosis with CT. AJR Am J Roentgenol 159:1217–1221

    Article  CAS  PubMed  Google Scholar 

  16. Sherck J, Shatney C, Sensaki K, Selivanov V (1994) The accuracy of computed tomography in the diagnosis of blunt small-bowel perforation. Am J Surg 168:670–675

    Article  CAS  PubMed  Google Scholar 

  17. Cook DE, Walsh JW, Vick CW, Brewer WH (1986) Upper abdominal trauma: pitfalls in CT diagnosis. Radiology 159:65–69

    Article  CAS  PubMed  Google Scholar 

  18. Kearney PA Jr, Vahey T, Burney RE, Glazer G (1989) Computed tomography and diagnostic peritoneal lavage in blunt abdominal trauma. Their combined role. Arch Surg 124:344–347

    Article  PubMed  Google Scholar 

  19. Wisner DH, Chun Y, Blaisdell FW (1990) Blunt intestinal injury. Keys to diagnosis and management. Arch Surg 125:1319–1322 (discussion 1322–1313)

    Article  CAS  PubMed  Google Scholar 

  20. Tsang BD, Panacek EA, Brant WE, Wisner DH (1997) Effect of oral contrast administration for abdominal computed tomography in the evaluation of acute blunt trauma. Ann Emerg Med 30:7–13

    Article  CAS  PubMed  Google Scholar 

  21. Hamilton P, Rizoli S, McLellan B, Murphy J (1995) Significance of intra-abdominal extraluminal air detected by CT scan in blunt abdominal trauma. J Trauma 39:331–333

    Article  CAS  PubMed  Google Scholar 

  22. Stuhlfaut JW, Anderson SW, Soto JA (2007) Blunt abdominal trauma: current imaging techniques and CT findings in patients with solid organ, bowel, and mesenteric injury. Semin Ultrasound CT MR 28:115–129

    Article  PubMed  Google Scholar 

  23. Hagiwara A, Yukioka T, Satou M, et al. (1995) Early diagnosis of small intestine rupture from blunt abdominal trauma using computed tomography: significance of the streaky density within the mesentery. J Trauma 38:630–633

    Article  CAS  PubMed  Google Scholar 

  24. Scaglione M, Pinto F, Lassandro F, et al. (2002) Value of contrast-enhanced CT for managing mesenteric injuries after blunt trauma: review of five-year experience. Emerg Radiol 9:26–31

    Article  PubMed  Google Scholar 

  25. Federle MP (2000) Traumatic injury to the bowel and mesentery. Berlin: Springer

    Book  Google Scholar 

  26. Dowe MF, Shanmuganathan K, Mirvis SE, Steiner RC, Cooper C (1997) CT findings of mesenteric injury after blunt trauma: implications for surgical intervention. AJR Am J Roentgenol 168:425–428

    Article  CAS  PubMed  Google Scholar 

  27. Brody JM, Leighton DB, Murphy BL, et al. (2000) CT of blunt trauma bowel and mesenteric injury: Typical findings and pitfalls in diagnosis. Radiographics 20:1525–1536 (discussion 1536–1527)

    Article  CAS  PubMed  Google Scholar 

  28. Stuhlfaut JW, Soto JA, Lucey BC, et al. (2004) Blunt abdominal trauma: performance of CT without oral contrast material. Radiology 233:689–694

    Article  PubMed  Google Scholar 

  29. Bhagvan S, Turai M, Holden A, Ng A, Civil I (2013) Predicting hollow viscus injury in blunt abdominal trauma with computed tomography. World J Surg 37:123–126

    Article  PubMed  Google Scholar 

  30. Ekeh AP, Saxe J, Walusimbi M, et al. (2008) Diagnosis of blunt intestinal and mesenteric injury in the era of multidetector CT technology—are results better? J Trauma 65:354–359

    Article  PubMed  Google Scholar 

  31. Petrosoniak A, Engels PT, Hamilton P, Tien HC (2013) Detection of significant bowel and mesenteric injuries in blunt abdominal trauma with 64-slice computed tomography. J Trauma Acute Care Surg 74:1081–1086

    Article  PubMed  Google Scholar 

  32. Matsushima K, Mangel PS, Schaefer EW, Frankel HL (2013) Blunt hollow viscus and mesenteric injury: still underrecognized. World J Surg 37:759–765

    Article  PubMed  Google Scholar 

  33. Breen DJ, Janzen DL, Zwirewich CV, Nagy AG (1997) Blunt bowel and mesenteric injury: diagnostic performance of CT signs. J Comput Assist Tomogr 21:706–712

    Article  CAS  PubMed  Google Scholar 

  34. Ceraldi CM, Waxman K (1990) Computerized tomography as an indicator of isolated mesenteric injury. A comparison with peritoneal lavage. Am Surg 56:806–810

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indiana University Health Methodist Hospital, 1701 N. Senate Blvd, Room AG-176, Indianapolis, IN, 46202, USA

    Scott D. Steenburg & Matthew J. Petersen

  2. Department of Biostatistics, Indiana University School of Medicine, Richard M. Fairbanks School of Public Health, 410 W. Tenth Street, Suite 3000, Indianapolis, IN, 46202, USA

    Changyu Shen & Hongbo Lin

Authors
  1. Scott D. Steenburg
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  2. Matthew J. Petersen
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  3. Changyu Shen
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  4. Hongbo Lin
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Correspondence to Scott D. Steenburg.

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Steenburg, S.D., Petersen, M.J., Shen, C. et al. Multi-detector CT of blunt mesenteric injuries: usefulness of imaging findings for predicting surgically significant bowel injuries. Abdom Imaging 40, 1026–1033 (2015). https://doi.org/10.1007/s00261-014-0262-2

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