title: Educational Review of Predictive Value and Findings of Computed Tomography Scan in Diagnosing Bowel and Mesenteric Injuries After Blunt Trauma: Correlation With Trauma Surgery Findings in 163 Patients.
abstract: OBJECTIVE
  Laparotomy can detect bowel and mesenteric injuries in 1.2%-5% of patients following blunt abdominal trauma. Delayed diagnosis in such cases is strongly related to increased risk of ongoing sepsis, with subsequent higher morbidity and mortality. Computed tomography (CT) scanning is the gold standard in the evaluation of blunt abdominal trauma, being accurate in the diagnosis of bowel and mesenteric injuries in case of hemodynamically stable trauma patients. Aims of the present study are to 1) review the correlation between CT signs and intraoperative findings in case of bowel and mesenteric injuries following blunt abdominal trauma, analysing the correlation between radiological features and intraoperative findings from our experience on 25 trauma patients with small bowel and mesenteric injuries (SBMI); 2) identify the diagnostic specificity of those signs found at CT with practical considerations on the following clinical management; and 3) distinguish the bowel and mesenteric injuries requiring immediate surgical intervention from those amenable to initial nonoperative management.
  
  
  METHODS
  Between January 1, 2008, and May 31, 2010, 163 patients required laparotomy following blunt abdominal trauma. Among them, 25 patients presented bowel or mesenteric injuries. Data were analysed retrospectively, correlating operative surgical reports with the preoperative CT findings.
  
  
  RESULTS
  We are presenting a pictorial review of significant and frequent findings of bowel and mesenteric lesions at CT scan, confirmed intraoperatively at laparotomy. Moreover, the predictive value of CT scan for SBMI is assessed.
  
  
  CONCLUSIONS
  Multidetector CT scan is the gold standard in the assessment of intra-abdominal blunt abdominal trauma for not only parenchymal organs injuries but also detecting SBMI; in the presence of specific signs it provides an accurate assessment of hollow viscus injuries, helping the trauma surgeons to choose the correct initial clinical management.
authors.affiliation: Department of Radiology, Maggiore Hospital, Bologna Local Health District, Bologna, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cinquantini
authors.affiliation: Department of Emergency, Trauma Surgery Unit, Maggiore Hospital Trauma Center, Bologna Local Health District, Bologna, Italy.
authors.forename: Gregorio
authors.initials: G
authors.lastname: Tugnoli
authors.affiliation: Department of Emergency, Trauma Surgery Unit, Maggiore Hospital Trauma Center, Bologna Local Health District, Bologna, Italy.
authors.forename: Alice
authors.initials: A
authors.lastname: Piccinini
authors.affiliation: Department of Emergency, Trauma ICU, Trauma Center, Maggiore Hospital, Bologna Local Health District, Bologna, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Coniglio
authors.affiliation: Department of Radiology, Maggiore Hospital, Bologna Local Health District, Bologna, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Mannone
authors.affiliation: Department of Emergency, Trauma Surgery Unit, Maggiore Hospital Trauma Center, Bologna Local Health District, Bologna, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Biscardi
authors.affiliation: Department of Emergency, Trauma ICU, Trauma Center, Maggiore Hospital, Bologna Local Health District, Bologna, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gordini
authors.affiliation: Department of Emergency, Trauma Surgery Unit, Maggiore Hospital Trauma Center, Bologna Local Health District, Bologna, Italy. Electronic address: salomone.disaverio@gmail.com.
authors.forename: Salomone
authors.initials: S
authors.lastname: Di Saverio
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging* / Q000601:surgery*; D000328:Adult; D000368:Aged; D003287:Contrast Media; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007422:Intestines / Q000293:injuries*; D007479:Iopamidol; D007813:Laparotomy; D008297:Male; D008643:Mesentery / Q000293:injuries*; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000601:surgery*
chemical_list: D003287:Contrast Media; D007479:Iopamidol
keywords: Blunt abdominal trauma; Computed tomography scan; Emergency radiology; Mesenteric injuries; Small bowel and mesenteric injuries; Small bowel injuries; Trauma center; Trauma laparotomy; Trauma surgery