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.
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Minino AM, Smith BL (2001) Deaths preliminary data for 2000. Natl Vital Stat Rep 49:16–17
Rizzo MJ, Federle MP, Griffiths BG (1989) Bowel and mesenteric injury following blunt abdominal trauma: evaluation with CT. Radiology 173:143–148
Wisner DH, Chun Y, Blaisdell FW (1990) Blunt intestinal injury: keys to diagnosis and management. Arch Surg 125:1319–1323
Chan O, Vlahos L (2003) The abdomen and major trauma. In: Sutton D, Robinson PJA, Jenkins JPR, Allan PL et al (eds) Textbook of radiology and imaging, 7th edn. Churchill Livingstone, China, pp 691–709
Hanks PW, Brody JM (2003) Blunt injury to mesentry and small bowel: CT evaluation. Radiol Clin N Am 41:1171–1182
Malinoski DJ, Patel MS, Yakar DO, Green D, Qureshi F, Inaba K, Brown CV, Salim A (2010) A diagnostic delay of 5 hours increases the risk of death after blunt hollow viscus injury. J Trauma 69:84–87
Albanese CT, Meza MP, Gardner MJ, Smith SD, Rowe MI, Lynch JM (1996) Is computed tomography a useful adjunct to the clinical examination for the diagnosis of pediatric gastrointestinal perforation from blunt abdominal trauma in children? J Trauma 40(3):417–421
Malhotra AK, Fabian TC, Katsis SB, Gavant ML, Croce MA (2000) Blunt bowel and mesenteric injuries: the role screening computed tomography. J Trauma 48(6):991–1000
Miller LA, Shanmuganathan K (2005) Multidetector CT evaluation of abdominal trauma. Radiol Clin N Am 43:1079–1095
Yoshii H, Sato M, Yamamoto S et al (1998) Usefulness and limitations of ultrasonography in the initial evaluation of blunt abdominal trauma. J Trauma 45(1):45–53
Scaglione M, de Lutio di Castelguidone E, Scilpi M, Merola S, Diettrich AI, Lombardo P, Romano L, Grassi R (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(1):67–73
Killeen KL, Shanmuganathan K, Polletti PA, Cooper C, Mirvis SE (2001) Helical computed tomography of bowel and mesenteric injuries. J Trauma 51(1):26–36
Brofman N, Atr M, Epid D, Hanson JM, Grinblat L, Chughtai T, Brenneman F (2006) Evaluation of bowel and mesenteric blunt traum with multidetector CT. Radiographics 26:1119–1131
Federle MP (1998) Diagnosis of intestinal injuries by computed tomography and the use of oral contrast medium. Ann Emerg Med 31:769–771
Allen TL, Mueller MT, Bonk RT, Harker CP, Duffy OH, Stevens MH (2002) Computed tomographic scanning without oral contrast solution for blunt bowel and mesenteric injuries in abdominal trauma. J Trauma 53:79–85
Breen DL, Janzen DL, Zwirewich CV, Nagy AG (1997) Blunt bowel and mesenteric injury: diagnostic performance of CT signs. J Comput Assist Tomogr 21:706–712
Fakhry S, Watts D, Luchette FA, for the EAST Multi-institutional HV1 Research group (2003) Current diagnostic approaches lack sensitivity in the diagnosis of perforated blunt small bowel injury: analysis from 275,557 trauma admissions from the EAST Multi-institutinal trial. J Trauma 54:295–306
Rodriguez C, Barone JE, Wilbanks TO, Rha C, Miller K (2002) Isolated free fluid on computed tomographic scan in blunt abdominal trauma: a systematic review of incidence and management. J Trauma 53:79–85
Jenzen DL, Zwirewich CV, Breen DJ, Nagy A (1998) Diagnostic accuracy of helical CT for detection of blunt bowel and mesenteric injuries. Clin Radiol 53:193–197
Yu J, Fulcher AS, Turner MA, Cockrell C, Halvorsen RA (2011) Blunt bowel and mesenteric injury: MDCT diagnosis. Abdom Imaging 36:50–61
Fakhry SM, Brownstein M, Watts DD, Baker CC, Oller D (2000) 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 multicentre experience. J Trauma 48:408–415
Thompson SR, Holland AJ (2005) Perforating small bowel injuries in children: influence of time to operation on outcome. Injury 36:1029–1033
Atri M, Hanson JM, Grinblat L, Brofman N, Chughtai T, Tomlinson G (2008) Surgically important bowel and/or mesenteric injury in blunt trauma: accuracy of multidetector CT for evaluation. Radiology 249:524–533
Ekeh AP, Saxe J, Walusimbi M, Tchorz KM, Woods RJ, Anderson HL 3rd, McCarthy MC (2008) Diagnosis of blunt intestinal and mesenteric injury in the era of multidetctor CT technology—are results better? J Trauma 65:354–359
Lawson C, Daley BJ, Ormsby CD, Enderson B (2011) Missed injuries in the era of the trauma scan. J Trauma 70:452–456
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Magu, S., Agarwal, S. & Gill, R.S. Multi Detector Computed Tomography in the Diagnosis of Bowel Injury. Indian J Surg 74, 445–450 (2012). https://doi.org/10.1007/s12262-011-0405-4
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DOI: https://doi.org/10.1007/s12262-011-0405-4