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Multicenter Study
. 2019 Aug;218(2):266-270.
doi: 10.1016/j.amjsurg.2018.11.018. Epub 2018 Nov 28.

Occult bowel injury after blunt abdominal trauma

Tyler J Loftus  1 , Megan L Morrow  2 , Lawrence Lottenberg  3 , Martin D Rosenthal  4 , Chasen A Croft  5 , R Stephen Smith  6 , Frederick A Moore  7 , Scott C Brakenridge  8 , Robert Borrego  9 , Philip A Efron  10 , Alicia M Mohr  11
Affiliations
Multicenter Study

Occult bowel injury after blunt abdominal trauma

Tyler J Loftus et al. Am J Surg. 2019 Aug.

Abstract

Background: Following blunt abdominal trauma, bowel injuries are often missed on admission computed tomography (CT) scan.

Methods: Multicenter retrospective analysis of 176 adults with moderate-critical blunt abdominal trauma and admission CT scan who underwent operative exploration. Patients with a bowel injury missed on CT (n = 36, 20%) were compared to all other patients (n = 140, 80%).

Results: The missed injury group had greater incidence free fluid without solid organ injury on CT scan (44% vs. 25%, p = 0.038) and visceral adhesions (28% vs. 6%, p = 0.001). Independent predictors of missed bowel injury included prior abdominal inflammation (OR 3.74, 95% CI 1.37-10.18), CT evidence of free fluid in the absence of solid organ injury (OR 2.31, 95% CI 1.03-5.19) and intraoperative identification of visceral adhesions (OR 4.46, 95% CI 1.52-13.13).

Conclusions: Patients with visceral adhesive disease and indirect evidence of bowel injury on CT scan were more likely to have occult bowel injury.

Keywords: Adhesions; Bowel injury; Computed tomography; Surgery; Trauma.

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Figures

Figure 1:
Figure 1:
Derivation of the study population (CT: computed tomography).
See this image and copyright information in PMC

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