title: Can multidetector CT detect the site of gastrointestinal tract injury in trauma? - A retrospective study.
abstract: OBJECTIVE
  We aimed to assess the performance of computed tomography (CT) in localizing site of traumatic gastrointestinal tract (GIT) injury and determine the diagnostic value of CT signs in site localization.
  
  
  METHODS
  CT scans of 97 patients with surgically proven GIT or mesenteric injuries were retrospectively reviewed by radiologists blinded to surgical findings. Diagnosis of either GIT or mesenteric injuries was made. In patients with GIT injuries, site of injury and presence of CT signs such as focal bowel wall hyperenhancement, hypoenhancement, wall discontinuity, wall thickening, extramural air, intramural air, perivisceral infiltration, and active vascular contrast leak were evaluated.
  
  
  RESULTS
  Out of 97 patients, 90 had GIT injuries (70 single site injuries and 20 multiple site injuries) and seven had isolated mesenteric injury. The overall concordance between CT and operative findings for exact site localization was 67.8% (61/90), partial concordance rate was 11.1% (10/90), and discordance rate was 21.1% (19/90). For single site localization, concordance rate was 77.1% (54/70), discordance rate was 21.4% (15/70), and partial concordance rate was 1.4% (1/70). In multiple site injury, concordance rate for all sites of injury was 35% (7/20), partial concordance rate was 45% (9/20), and discordance rate was 20% (4/20). For upper GIT injuries, wall discontinuity was the most accurate sign for localization. For small bowel injury, intramural air and hyperenhancement were the most specific signs for site localization, while for large bowel injury, wall discontinuity and hypoenhancement were the most specific signs.
  
  
  CONCLUSIONS
  CT performs better in diagnosing small bowel injury compared with large bowel injury. CT can well predict the presence of multiple site injury but has limited performance in exact localization of all injury sites.
authors.affiliation: Department of Radiology, Jai Prakash Narayana Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India. dratinkumar@gmail.com.
authors.forename: Ananya
authors.initials: A
authors.lastname: Panda
authors.forename: Atin
authors.initials: A
authors.lastname: Kumar
authors.forename: Shivanand
authors.initials: S
authors.lastname: Gamanagatti
authors.forename: Ranjita
authors.initials: R
authors.lastname: Das
authors.forename: Swati
authors.initials: S
authors.lastname: Paliwal
authors.forename: Amit
authors.initials: A
authors.lastname: Gupta
authors.forename: Subodh
authors.initials: S
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D041981:Gastrointestinal Tract / Q000293:injuries*; D006801:Humans; D007420:Intestine, Large / Q000000981:diagnostic imaging; D007421:Intestine, Small / Q000000981:diagnostic imaging; D008297:Male; D008643:Mesentery / Q000293:injuries*; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D009104:Multiple Trauma / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014947:Wounds and Injuries / Q000000981:diagnostic imaging*; D055815:Young Adult