title: Blunt hollow viscus and mesenteric injury: still underrecognized.
abstract: BACKGROUND
  Despite the availability of more accurate imaging modalities, specifically multidetector computed tomography (MDCT), the diagnosis of non-ischemic (NI-) and ischemic (I-) blunt hollow viscus and mesenteric injury (BHVMI) remains challenging. We hypothesized that BHVMI can be still missed with newer generations of MDCT and that patients with I-BHVMI have a poorer outcome than those with NI-BHVMI.
  
  
  METHODS
  We performed an eight-year retrospective review at a level 1 trauma center. Ischemic-BHVMI was defined as devascularization confirmed at laparotomy. Non-ischemic-BHVMI included perforation, laceration, and hematoma without devascularization. The sensitivity of each generation of MDCT for BHVMI was calculated. Potential predictors and outcomes of I-BHVMI were compared to the NI-BHVMI group.
  
  
  RESULTS
  Of 7,875 blunt trauma patients, 67 patients (0.8 %) were included in the BHVMI group; 13 patients did not have any CT findings suggestive of BHVMI (sensitivity 81 %), and 11 of them underwent surgical intervention without delay (<5 h). Newer generations of MDCT were not associated with higher sensitivity. Patients with I-BHVMI had a significantly higher rate of delayed laparotomy ≥ 12 h (23 % versus 2 %; p = 0.01) and a significantly longer length of hospital stay (median 14 versus 9 days; p = 0.02) than those with NI-BHVMI.
  
  
  CONCLUSIONS
  Even using an advanced imaging technique, the diagnosis of I-BHVMI can be delayed, with significant negative impact on patient outcome.
authors.affiliation: Division of Trauma, Acute Care and Critical Care Surgery, Department of Surgery, Penn State Milton S. Hershey Medical Center, 500 University Drive, P.O. Box 850, MC H075, Hershey, PA 17036, USA. kmatsushima@hmc.psu.edu
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Matsushima
authors.forename: Patricia S
authors.initials: PS
authors.lastname: Mangel
authors.forename: Eric W
authors.initials: EW
authors.lastname: Schaefer
authors.forename: Heidi L
authors.initials: HL
authors.lastname: Frankel
mesh_terms: D000328:Adult; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007422:Intestines / Q000098:blood supply / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D007511:Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008643:Mesentery / Q000098:blood supply / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013270:Stomach / Q000098:blood supply / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D014193:Trauma Centers; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery