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Diagnostic accuracy of triple-contrast multi-detector computed tomography for detection of penetrating gastrointestinal injury: a prospective study

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Abstract

Purpose

Neither the performance of CT in diagnosing penetrating gastrointestinal injury nor its ability to discriminate patients requiring either observation or surgery has been determined.

Materials and methods

This was a prospective, single-institutional observational study of patients with penetrating injury to the torso who underwent CT. Based on CT signs, reviewers determined the presence of a gastrointestinal injury and the need for surgery or observation. The primary outcome measures were operative findings and clinical follow-up. CT results were compared with the primary outcome measures.

Results

Of one hundred and seventy-one patients (72 gunshot wounds, 99 stab wounds; age range, 18–57 years; median age, 28 years) with penetrating torso trauma who underwent CT, 45 % were followed by an operation and 55 % by clinical follow up. Thirty-five patients had a gastrointestinal injury at surgery. The sensitivity, specificity, and accuracy of CT for diagnosing a gastrointestinal injury for all patients were each 91 %, and for predicting the need for surgery, they were 94 %, 93 %, 93 %, respectively. Among the 3 % of patients who failed observation, 1 % had a gastrointestinal injury.

Conclusion

CT is a useful technique to diagnose gastrointestinal injury following penetrating torso injury. CT can help discriminate patients requiring observation or surgery.

Key Points

• The most sensitive sign is wound tract extending up to gastrointestinal wall.

• The most accurate sign is gastrointestinal wall thickening.

• Triple-contrast CT is a useful technique to diagnose gastrointestinal injury.

• Triple-contrast CT helps to discriminate patients requiring observation and surgery.

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Acknowledgements

The scientific guarantors of this publication are Kathirkamanathan Shanmuganathan & Nitima Saksobhavivat. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Methodology: prospective, observational, performed at one institution.

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Authors and Affiliations

  1. Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd., Ratchathewi, Bangkok, 10400, Thailand

    Nitima Saksobhavivat

  2. Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, 22 S. Greene Street, Baltimore, MD, 21201, USA

    Kathirkamanathan Shanmuganathan, Alexis R. Boscak, Clint W. Sliker, Uttam K. Bodanapally, Krystal Archer-Arroyo, Lisa A. Miller, Thorsten R. Fleiter, Melvin T. Alexander & Stuart E. Mirvis

  3. R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S. Greene Street, Baltimore, MD, 21201, USA

    Deborah M. Stein & Thomas M. Scalea

Authors
  1. Nitima Saksobhavivat
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  2. Kathirkamanathan Shanmuganathan
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  3. Alexis R. Boscak
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  4. Clint W. Sliker
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  6. Uttam K. Bodanapally
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  10. Melvin T. Alexander
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  11. Stuart E. Mirvis
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Corresponding author

Correspondence to Kathirkamanathan Shanmuganathan.

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Saksobhavivat, N., Shanmuganathan, K., Boscak, A.R. et al. Diagnostic accuracy of triple-contrast multi-detector computed tomography for detection of penetrating gastrointestinal injury: a prospective study. Eur Radiol 26, 4107–4120 (2016). https://doi.org/10.1007/s00330-016-4260-3

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  • DOI: https://doi.org/10.1007/s00330-016-4260-3

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