Blunt bowel and mesenteric injury: diagnostic performance of CT signs.
OBJECTIVE
Our goal was to determine the sensitivity and specificity of various CT signs of blunt bowel and mesenteric injury.


METHODS
The CT findings of 31 patients with blunt abdominal trauma were retrospectively assessed by three observers in consensus. All patients had laparotomy within 24 h of CT. The study group consisted of 19 patients with surgically proven bowel and/or mesenteric injury. The control group consisted of 12 traumatized patients who had no bowel or mesenteric injury. The CT signs assessed were presence, location, and extent of intraperitoneal fluid, extraluminal air, bowel wall thickening, bowel wall discontinuity, mesenteric streaking, and mesenteric hematoma.


RESULTS
In the 12 cases of bowel injury (9 transmural injury, 3 partial thickness injury), the CT sign of bowel wall thickening had sensitivity of 50% and specificity of 84% and the CT sign of bowel wall discontinuity had sensitivity of 58% and specificity of 95%. Extraluminal air was a specific but relatively insensitive sign of transmural bowel injury (sensitivity 44%, specificity 100%). In the 13 patients with mesenteric injuries, the CT sign of mesenteric hematoma had sensitivity of 54% and specificity of 94%. Isolated mesenteric streaking was a less specific sign of mesenteric injury (sensitivity 77%, specificity 44%). The finding of peritoneal fluid with no visible solid organ injury was a useful sign of bowel or mesenteric injury, occurring in 11 of 19 (58%) study patients and none of the controls (p < 0.001).


CONCLUSIONS
Bowel wall thickening, bowel wall discontinuity, extraluminal air, and mesenteric hematoma are reasonably specific CT signs of bowel and mesenteric injury following blunt abdominal trauma. The presence of a moderate to large volume of intraperitoneal fluid without visible solid organ injury is an important sign of bowel or mesenteric injury.
Breen
D J
DJ
Department of Radiology, Vancouver Hospital and Health Sciences Centre, BC, Canada.
Janzen
D L
DL
Zwirewich
C V
CV
Nagy
A G
AG
D000007:Abdominal Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000388:Air; D001202:Ascitic Fluid / Q000000981:diagnostic imaging; D003287:Contrast Media; D003288:Contusions / Q000000981:diagnostic imaging; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging; D006801:Humans; D007422:Intestines / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D007482:Iothalamate Meglumine; D007668:Kidney / Q000000981:diagnostic imaging / Q000293:injuries; D007813:Laparotomy; D008099:Liver / Q000000981:diagnostic imaging / Q000293:injuries; D008297:Male; D008643:Mesentery / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D008875:Middle Aged; D012189:Retrospective Studies; D012421:Rupture; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D013154:Spleen / Q000000981:diagnostic imaging / Q000293:injuries; D014057:Tomography, X-Ray Computed; D014283:Triiodobenzoic Acids; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000601:surgery
D003287:Contrast Media; D014283:Triiodobenzoic Acids; C054871:ioversol; D007482:Iothalamate Meglumine