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Detection of significant bowel and mesenteric injuries in blunt abdominal trauma with 64-slice computed tomography

Petrosoniak, Andrew MD; Engels, Paul T. MD; Hamilton, Paul MD; Tien, Homer C. MD, MSc

Journal of Trauma and Acute Care Surgery: April 2013 - Volume 74 - Issue 4 - p 1081–1086
doi: 10.1097/TA.0b013e3182827178
Original Articles

BACKGROUND: Approximately 5% of blunt abdominal trauma patients experience blunt bowel and mesenteric injuries (BBMIs). The diagnosis may be elusive as computed tomography (CT) can occasionally miss these injuries. Recent advancements in CT technology, however, may improve detection rates. This study will assess the false-negative rate of BBMI using a 64-slice computed tomographic scanner in adults with blunt abdominal trauma.

METHODS: All blunt abdominal trauma patients with laparotomy confirmed BBMI were retrospectively identified within a 5-year period at a Level I trauma center. Only patients who underwent preoperative abdominal CT were included. CT reports were examined specifically for findings suggestive of BBMI and compared with operative findings. A completely normal computed tomographic scan result as interpreted by a staff radiologist but operative findings of BBMI was considered a false negative.

RESULTS: One hundred ninety five cases of laparotomy-proven BBMI were identified from the trauma registry, of which 68 patients met study inclusion criteria. All study patients had free fluid present on CT. As a result, there were no false-negative computed tomographic scan results for BBMI. Four patients had isolated small amounts of free fluid without any additional suggestive CT findings of BBMI or solid-organ injury. Mesenteric or bowel hematomas and bowel wall thickening were present in 57% and 50% of cases, respectively.

CONCLUSION: The false-negative rates of BBMI may be reduced with a 64-slice computed tomographic scan. In this study, all patients had free fluid identified on CT. Consequently, even minimal free fluid remains relevant in patients with blunt abdominal injury.

LEVEL OF EVIDENCE: Diagnostic test, level III.

From the Division of Emergency Medicine (A.P.), Department of Medicine, University of Toronto; Division of General Surgery (H.C.T.), and Medical Imaging Department (P.H.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto; and Canadian Forces Health Services (H.C.T.), Ottawa, Ontario; Division of Critical Care Medicine (P.T.E.), Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.

Submitted: September 28, 2012, Revised: November 15, 2012, Accepted: November 20, 2012.

Address for reprints: Andrew Petrosoniak, MD, Royal College Emergency Medicine Residency Program, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, C7-53, Toronto, Ontario, M4N 3M5; email: andrew.petrosoniak@mail.utoronto.ca.

© 2013 Lippincott Williams & Wilkins, Inc.