Computed tomography has an important role in hollow viscus and mesenteric injuries after blunt abdominal trauma.
BACKGROUND
Computed tomographic (CT) scans have become invaluable in the management of patients with blunt abdominal trauma. No clear consensus exists on its role in hollow viscus injuries (HVI) and mesenteric injuries (MI). The aim of this study was to correlate operative findings of HVI and MI to findings on pre-operative CT.


METHODS
All patients treated for blunt abdominal trauma at Tan Tock Seng Hospital from January 2003 to January 2008 were reviewed. CT scans were only performed if the patients were haemodynamically stable and indicated. All scans were performed with intravenous contrast using a 4-slice CT scanner from 2003 to December 2004 and a 64-slice CT scanner from January 2005 onwards. All cases with documented HVI/MI that underwent both CT scans and exploratory laparotomy were analysed.


RESULTS
Thirty-one patients formed the study group, with median age of 40 (range, 22-65) years and a significant male (83.9%) predominance. Vehicular-related incidents accounted for 67.7% of the injuries and the median Injury Severity Score (ISS) was 13 (4-50). The 2 commonest findings on CT scans were extra-luminal gas (35.5%) and free fluid without significant solid organ injuries (93.5%). During exploratory laparotomy, perforation of hollow viscus (51.6%) occurred more frequently than suspected from the initial CT findings of extra-luminal gas. Other notable findings included haemoperitoneum (64.5%), and mesenteric tears (67.7%). None of our patients with HVI and MI had a normal pre-operative CT scan.


CONCLUSIONS
Our study suggests that patients with surgically confirmed HVI and MI found at laparotomy were very likely to have an abnormal pre-operative CT scan. Unexplained free fluid was a very common finding in blunt HVI/MI and is one major indication to consider exploratory laparotomy.
Tan
Ker-Kan
KK
TTSH-NNI Trauma Centre, Tan Tock Seng Hospital, Singapore. kerkan@gmail.com
Liu
Jody Zhiyang
JZ
Go
Tsung-Shyen
TS
Vijayan
Appasamy
A
Chiu
Ming-Terk
MT
D000007:Abdominal Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D000328:Adult; D000368:Aged; D001202:Ascitic Fluid / Q000000981:diagnostic imaging*; D003287:Contrast Media; D005260:Female; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D015601:Injury Severity Score; D007813:Laparotomy; D007902:Length of Stay; D008297:Male; D008643:Mesentery / Q000000981:diagnostic imaging / Q000293:injuries*; D008875:Middle Aged; D011027:Pneumoperitoneum / Q000000981:diagnostic imaging / Q000601:surgery; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D014781:Viscera / Q000000981:diagnostic imaging / Q000293:injuries*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000601:surgery; D055815:Young Adult
D003287:Contrast Media