Advertisement

CT Scan in Blunt Gastrointestinal Trauma

  • Gustavo Pereira Fraga
  • Rao Ivatury
Chapter
Part of the Hot Topics in Acute Care Surgery and Trauma book series (HTACST)

Abstract

Abdominal injury as a result of penetrating or blunt trauma may represent a life-threatening condition requiring rapid diagnosis and treatment. The Eastern Association for the Surgery of Trauma Multi-institutional Hollow Viscus Injury (HVI) study, the largest retrospective hollow viscus injury to date, found the incidence of blunt small bowel injury (BSBI) of 1.1%, blunt colonic injury as 0.3% (30.2% of patients diagnosed with HVI had a colon injury), and the incidence of blunt gastric injury to be much lower (only 4.3% of a total of 2632 patients identified with HVI) [1, 2].

Blunt small bowel injury (BSBI) is an infrequent diagnosis. The knowledge of the mechanism of trauma and types of BSBI are important because the diagnosis of these injuries remains a problem. The introduction of abdominal CT scan as the primary diagnostic method for blunt abdominal trauma in hemodynamically stable patients has provided an accurate assessment of hollow viscus injuries in the presence of specific signs, helping the trauma surgeons to choose the correct management. The risk of missed BSBI is a challenge because delay in the diagnosis may occur and contribute significantly to increase morbidity and mortality.

References

  1. 1.
    Watts DD, Fakhry SM. EAST multi-institutional hollow viscus injury research group. Incidence of hollow viscus injury in blunt trauma: an analysis from 275,557 trauma admissions from the East multi-institutional trial. J Trauma. 2003;54(2):289–94.CrossRefPubMedGoogle Scholar
  2. 2.
    Williams MD, Watts D, Fakhry S. Colon Injury after blunt abdominal trauma: results of the EAST multi-institutional hollow viscus injury study. J Trauma. 2003;55(5):906–12.CrossRefPubMedGoogle Scholar
  3. 3.
    Burney RE, Mueller GL, Coon WW, Thomas EJ, Mackenzie JR. Diagnosis of isolated small bowel injury following blunt abdominal trauma. Ann Emerg Med. 1983;12(2):71–4.CrossRefPubMedGoogle Scholar
  4. 4.
    Fakhry SM, Brownstein M, Watts DD, Baker CC, Oller D. Relatively short diagnostic delays (<8 hours) 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. 2000;48(3):408–15.CrossRefPubMedGoogle Scholar
  5. 5.
    Fraga GP, Souza e Silva FHB, Almeida NA, Curi JCM, Mantovani M. Blunt abdominal trauma with small bowel injury: are isolated lesions riskier than associated lesions? Acta Cir Bras. 2008;23(2):196–201.CrossRefPubMedGoogle Scholar
  6. 6.
    Yu J, Fulcher AS, Turner MA, Cockrell C, Halvorsen RA. Blunt bowel and mesenteric injury: MDCT diagnosis. Abdom Imaging. 2011;36(1):50–61.CrossRefPubMedGoogle Scholar
  7. 7.
    Thompson SR, Holland AJA. Perforating small bowel injuries in children: influence of time to operative operation on outcome. Injury. 2005;36:1029–33.CrossRefPubMedGoogle Scholar
  8. 8.
    Robbs JV, Moore SW, Pillay SP. Blunt abdominal trauma with jejunal injury: a review. J Trauma. 1980;20(4):308–11.PubMedGoogle Scholar
  9. 9.
    Schenk WG 3rd, Lonchyna V, Moylan JA. Perforation of the jejunum from blunt abdominal trauma. J Trauma. 1983;23(1):54–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Shapiro MB, Nance ML, Schiller HJ, Hoff WS, Kauder DR, Schwab CW. Nonoperative management of solid abdominal organ injuries from blunt trauma: impact of neurologic impairment. Am Surg. 2001;67:793–6.PubMedGoogle Scholar
  11. 11.
    Scaglione M, de Lutio di Castelguidone E, Scialpi M, Merola S, Diettrich AI, Lombardo P, et al. Blunt trauma to the gastrointestinal tract and mesentery: is there a role for helical CT in the decision-making process? Eur J Radiol. 2004;50(1):67–73.CrossRefPubMedGoogle Scholar
  12. 12.
    Saku M, Yoshimitsu K, Murakami J, Nakamura Y, Oguri S, Noguchi T, et al. Small bowel perforation resulting from blunt abdominal trauma: interval change of radiological characteristics. Radiat Med. 2006;24(5):358–64.CrossRefPubMedGoogle Scholar
  13. 13.
    Zissin R, Osadchy A, Gayer G. Abdominal CT findings in small bowel perforation. Br J Radiol. 2009;82(974):162–71.CrossRefPubMedGoogle Scholar
  14. 14.
    Lawson CM, Daley BJ, Ormsby CB, Enderson B. Missed injuries in the era of the trauma scan. J Trauma. 2011;70(2):452–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Jha NK, Yadav SK, Sharma R, Sinha DK, Kumar S, Kerketta MD, et al. Characteristics of hollow viscus injury following blunt abdominal trauma; a single Centre experience from eastern India. Bull Emerg Trauma. 2014;2(4):156–60.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Miller LA, Shanmuganathan K. Multidetector CT evaluation of abdominal trauma. Radiol Clin North Am. 2005;43(6):1079–95.CrossRefPubMedGoogle Scholar
  17. 17.
    Soto JA, Anderson SW. Multidetector CT of blunt abdominal trauma. Radiology. 2012;265(3):678–93.CrossRefPubMedGoogle Scholar
  18. 18.
    Ekeh AP, Saxe J, Walusimbi M, Tchorz KM, Woods RJ, Anderson HL 3rd, et al. Diagnosis of blunt intestinal and mesenteric injury in the era of multidetector CT technology—are results better? J Trauma. 2008;65(2):354–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Matsushima K, Mangel PS, Schaefer EW, Frankel HL. Blunt hollow viscus and mesenteric injury: still underrecognized. World J Surg. 2013;37(4):759–65.CrossRefPubMedGoogle Scholar
  20. 20.
    de Araújo RO, de Matos MP, Penachim TJ, Pereira BM, Mantovani ME, Rizoli S, et al. Jejunum and ileum blunt trauma: what has changed with the implementation of multislice computed tomography? Rev Col Bras Cir. 2014;41(4):278–84.CrossRefPubMedGoogle Scholar
  21. 21.
    Brody JM, Leighton DB, Murphy BL, Abbott GF, Vaccaro JP, Jagminas L, et al. CT of blunt trauma bowel and mesenteric injury: typical findings and pitfalls in diagnosis. Radiographics. 2000;20(6):1525–37.CrossRefPubMedGoogle Scholar
  22. 22.
    Fakhry SM, Watts DD, Luchette FA. Current diagnostic approaches lack sensitivity in the diagnosis of perforated blunt small bowel injury: analysis from 275,557 trauma admissions from the EAST multi-institutional HVI trial. J Trauma. 2003;54:295–306.CrossRefPubMedGoogle Scholar
  23. 23.
    Kemmeter PR, Senagore AJ, Smith D, Oostendorp L. Dilemmas in the diagnosis of blunt enteric trauma. Am Surg. 1998;64:750–4.PubMedGoogle Scholar
  24. 24.
    Fang JF, Chen RJ, Lin BC, Hsu YB, Kao JL, Kao YC, et al. Small bowel perforation: is urgent surgery necessary? J Trauma. 1999;47(3):515–20.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Trauma Surgery, Department of Surgery, School of Medical SciencesUniversity of CampinasCampinasBrazil
  2. 2.Virginia Commonwealth UniversityRichmondUSA

Personalised recommendations