Are We Missing Traumatic Bowel and Mesenteric Injuries?
OBJECTIVE
Traumatic bowel and mesenteric injury (TBMI), although an uncommon entity, can be lethal if not detected and treated in a timely manner. The purpose of our study was to evaluate the diagnostic accuracy of 64-slice multidetector computed tomography (MDCT) for the detection of TBMI in patients at our level 1 trauma centre.


METHODS
We used our hospital's trauma registry to identify patients with a diagnosis of TBMI from January 1, 2006, to June 30, 2013. Only patients who had a 64-slice MDCT scan at presentation and subsequently underwent laparotomy or laparoscopy were included in the study cohort. Using the surgical findings as the gold standard, the accuracy of prospective radiology reports was analyzed.


RESULTS
Of the 4781 trauma patients who presented to our institution, 44 (0.92%) had surgically proven TBMI. Twenty-two of 44 were excluded as they did not have MDCT before surgery. The study cohort consisted of 14 males and 8 females with a median age of 41.5 years and a median injury severity score of 27. In total 17 of 22 had blunt trauma and 5 of 22 had penetrating injury. A correct preoperative imaging diagnosis of TBMI was made in 14 of 22 of patients. The overall sensitivity of the radiology reports was 63.6% (95% confidence interval [CI]: 41%-82%), specificity was 79.6% (95% CI: 67%-89%), PPV was 53.9% (95% CI: 33%-73%), and the NPV was 85.5% (95% CI: 73%-94%). Accuracy was calculated at 75.3%. However, only 59% (10 of 17) of patients with blunt injury had a correct preoperative diagnosis. Review of the findings demonstrated that majority of patients with missed blunt TBMI (5 of 7) demonstrated only indirect signs of injury.


CONCLUSIONS
The detection of TBMI in trauma patients on 64-slice MDCT can be improved, especially in patients presenting with blunt injury. Missed cases in this population occurred because the possibility of TBMI was not considered despite the presence of indirect imaging signs. The prospective diagnosis of TBMI remains challenging despite advances in CT technology and widespread use of 64-slice MDCT.
Division of Emergency/Trauma Radiology, Department of Radiology, Michael DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
Bret A
BA
Landry
Division of Emergency/Trauma Radiology, Department of Radiology, Michael DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada. Electronic address: patlas@hhsc.ca.
Michael N
MN
Patlas
Department of Surgery, Michael DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
Samir
S
Faidi
Department of Surgery, Michael DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
Angela
A
Coates
Division of Emergency/Trauma Radiology, Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
Savvas
S
Nicolaou
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007422:Intestines / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D008643:Mesentery / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D057234:Preoperative Period; D012189:Retrospective Studies; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging*; D055815:Young Adult
Bowel injury; Mesenteric injury; Multidetector computed tomography; Trauma