Multi detector computed tomography in the diagnosis of bowel injury

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.

Keywords: MDCT; Minor signs; Missed injuries.

Fig. 1

Axial contrast enhanced CT scan of a 10 year old female child who reported 7 hrs following handle bar injury, reveals injury to the first part of the duodenum with extravasation of contrast. There is associated massive disruption of the pancreatic head

Fig. 2

Axial contrast enhanced CT scan of a 60 year old male patient who presented 10 hrs following road traffic accident, reveals break in the continuity of descending colon and massive pneumoperitoneum

Fig. 3

Axial contrast-enhanced CT scan of a 48 year old Male patient reveals air in the viscinity of bowel with mesenteric hematoma and stranding. Pre-operatively there was mesenteric tear and resultant ileal gangrene

Fig. 4

Patient of head trauma with no illicitable abdominal signs was found to have gut wall hematoma of the caecum and ascending colon with hematoma of mesocolon and retroperitoneal fluid, on CT scan examination. Preoperatively there was tear in mesocolon with Gangrene of ascending colon

Fig. 5

Axial contrast enhanced CT scan of a 12 year old male child who presented 6 hrs following road traffic accident, reveals herniation of small bowel loops into the left Psoas muscle