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. 2021 Apr;73(2):703-710.
doi: 10.1007/s13304-020-00929-w. Epub 2020 Dec 19.

Traumatic hollow viscus and mesenteric injury: role of CT and potential diagnostic-therapeutic algorithm

Alessandro Michele Bonomi  1 , Stefano Granieri  2 , Shailvi Gupta  3 , Michele Altomare  1 , Stefano Piero Bernardo Cioffi  1 , Fabrizio Sammartano  4 , Stefania Cimbanassi  4 , Osvaldo Chiara  5
Affiliations

Traumatic hollow viscus and mesenteric injury: role of CT and potential diagnostic-therapeutic algorithm

Alessandro Michele Bonomi et al. Updates Surg. 2021 Apr.

Abstract

Despite its rarity, traumatic hollow viscus and mesenteric injury (HVMI) have high mortality and complication rates. There is no consensus regarding its best management. Our aim is to evaluate contrast enhanced CT (ceCT) in the screening of HVMI and its capability to assess the need for surgery. All trauma patients admitted to an urban Level 1 trauma center between 2010 and 2018 were retrospectively evaluated. Patients with ceCT scan prior to laparotomy were included. Patients requiring surgical repair of HVMI and a ceCT scan consistent with HVMI were considered true positives. Six ceCT scan criteria for HVMI were used; at least one criterion was considered positive for HVMI. Sensitivity (Sn), specificity (Sp), predictive values (PV), likelihood ratios (LR) and accuracy (Ac) of ceCT of single ceCT criteria and of the association of ceCT criteria were calculated using intraoperative findings as gold standard. Therapeutic time (TT), death probability (DP), and observed mortality (OM) were described. 114 of 4369 patients were selected for ceCT accuracy analysis; 47 were considered true positives. Sn of ceCT for HVMI was 97.9%, Sp 63.6%, PPV 66.2%, NPV 97.6%, + LR 2.69, -LR 0.03, Ac 78%; no single criterion stood out. The association of four or more criteria improved ceCT Sp to 98.5%, PPV to 95.6%, + LR to 30.5. Median TT was 2 h (IQR: 1-3 h). OM was 7.8%-not significantly higher than overall OM. CeCT in trauma has become a reliable screening test for HVMI and a valid exam to select HVMI patients for surgical exploration.

Keywords: Blunt trauma; CT scan; Hollow viscus; Penetrating trauma.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Flowchart of study design
Fig. 2
Fig. 2
Potential algorithm for HVMI based on number of ceCT criteria
See this image and copyright information in PMC

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