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Erschienen in: La radiologia medica 1/2015

01.01.2015 | EMERGENCY RADIOLOGY

Bowel and mesenteric injuries from blunt abdominal trauma: a review

verfasst von: Francesco Iaselli, Maria Antonietta Mazzei, Cristina Firetto, Domenico D’Elia, Nevada Cioffi Squitieri, Pietro Raimondo Biondetti, Francesco Maria Danza, Mariano Scaglione

Erschienen in: La radiologia medica | Ausgabe 1/2015

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Abstract

The bowel and the mesentery represent the third most frequently involved structures in blunt abdominal trauma after the liver and the spleen. Clinical assessment alone in patients with suspected intestinal and/or mesenteric injury from blunt abdominal trauma is associated with unacceptable diagnostic delays. Multi-detector computed tomography, thanks to its high spatial, time and contrast resolutions, allows a prompt identification and proper classification of such conditions. The radiologist, in fact, is asked not only to identify the signs of trauma but also to provide an indication of their clinical significance, suggesting the chance of conservative treatment in the cases of mild and moderate, non-complicated or self-limiting injuries and focusing on life-threatening conditions which may benefit from immediate surgical or interventional procedures. Specific and non-specific CT signs of bowel and mesenteric injuries from blunt abdominal trauma are reviewed in this paper.
Literatur
1.
Zurück zum Zitat Atri M, Hanson JM, Grinblat L, Brofman N, Chughtai T, Tomlinson G (2008) Surgically important bowel and/or mesenteric injury in blunt trauma: accuracy of multidetector CT for evaluation. Radiology 249(2):524–533. doi:10.1148/radiol.2492072055 PubMedCrossRef Atri M, Hanson JM, Grinblat L, Brofman N, Chughtai T, Tomlinson G (2008) Surgically important bowel and/or mesenteric injury in blunt trauma: accuracy of multidetector CT for evaluation. Radiology 249(2):524–533. doi:10.​1148/​radiol.​2492072055 PubMedCrossRef
2.
Zurück zum Zitat Butela ST, Federle MP, Chang PJ, Thaete FL, Peterson MS, Dorvault CJ, Hari AK, Soni S, Branstetter BF, Paisley KJ, Huang LF (2001) Performance of CT in detection of bowel injury. AJR Am J Roentgenol 176(1):129–135PubMedCrossRef Butela ST, Federle MP, Chang PJ, Thaete FL, Peterson MS, Dorvault CJ, Hari AK, Soni S, Branstetter BF, Paisley KJ, Huang LF (2001) Performance of CT in detection of bowel injury. AJR Am J Roentgenol 176(1):129–135PubMedCrossRef
4.
Zurück zum Zitat Scaglione M, de Lutio di Castelguidone E, Scialpi M, Merola S, Diettrich AI, Lombardo P, Romano L, Grassi R (2004) Blunt trauma to the gastrointestinal tract and mesentery: is there a role for helical CT in the decision-making process? Eur J Radiol 50(1):67–73PubMedCrossRef Scaglione M, de Lutio di Castelguidone E, Scialpi M, Merola S, Diettrich AI, Lombardo P, Romano L, Grassi R (2004) Blunt trauma to the gastrointestinal tract and mesentery: is there a role for helical CT in the decision-making process? Eur J Radiol 50(1):67–73PubMedCrossRef
5.
Zurück zum Zitat Watts DD, Fakhry SM (2003) Incidence of hollow viscus injury in blunt trauma: an analysis from 275,557 trauma admissions from the East multi-institutional trial. J Trauma 54(2):289–294PubMedCrossRef Watts DD, Fakhry SM (2003) Incidence of hollow viscus injury in blunt trauma: an analysis from 275,557 trauma admissions from the East multi-institutional trial. J Trauma 54(2):289–294PubMedCrossRef
6.
Zurück zum Zitat Fakhry SM, Brownstein M, Watts DD, Baker CC, Oller D (2000) Relatively short diagnostic delays (<8 hours) produce morbidity and mortality in blunt small bowel injury: an analysis of time to operative intervention in 198 patients from a multicenter experience. J Trauma 48(3):408–414 (corrected)PubMedCrossRef Fakhry SM, Brownstein M, Watts DD, Baker CC, Oller D (2000) Relatively short diagnostic delays (<8 hours) produce morbidity and mortality in blunt small bowel injury: an analysis of time to operative intervention in 198 patients from a multicenter experience. J Trauma 48(3):408–414 (corrected)PubMedCrossRef
7.
Zurück zum Zitat Malinoski DJ, Patel MS, Yakar DO, Green D, Qureshi F, Inaba K, Brown CV, Salim A (2010) A diagnostic delay of 5 hours increases the risk of death after blunt hollow viscus injury. J Trauma 69(1):84–87PubMedCrossRef Malinoski DJ, Patel MS, Yakar DO, Green D, Qureshi F, Inaba K, Brown CV, Salim A (2010) A diagnostic delay of 5 hours increases the risk of death after blunt hollow viscus injury. J Trauma 69(1):84–87PubMedCrossRef
10.
Zurück zum Zitat Yegiyants S, Abou-Lahoud G, Taylor E (2006) The management of blunt abdominal trauma patients with computed tomography scan findings of free peritoneal fluid and no evidence of solid organ injury. Am Surg 72(10):943–946PubMed Yegiyants S, Abou-Lahoud G, Taylor E (2006) The management of blunt abdominal trauma patients with computed tomography scan findings of free peritoneal fluid and no evidence of solid organ injury. Am Surg 72(10):943–946PubMed
11.
Zurück zum Zitat Walker ML, Akpele I, Spence SD, Henderson V (2012) The role of repeat computed tomography scan in the evaluation of blunt bowel injury. Am Surg 78(9):979–985PubMed Walker ML, Akpele I, Spence SD, Henderson V (2012) The role of repeat computed tomography scan in the evaluation of blunt bowel injury. Am Surg 78(9):979–985PubMed
13.
14.
Zurück zum Zitat Scaglione M, Linsenmaier U, Schueller G (2012) Emergency radiology of the abdomen. Springer Gmbh, BerlinCrossRef Scaglione M, Linsenmaier U, Schueller G (2012) Emergency radiology of the abdomen. Springer Gmbh, BerlinCrossRef
15.
Zurück zum Zitat Bondia JM, Anderson SW, Rhea JT, Soto J (2009) Imaging colorectal trauma using 64-MDCT technology. Emerg Radiol 16(6):433–440PubMedCrossRef Bondia JM, Anderson SW, Rhea JT, Soto J (2009) Imaging colorectal trauma using 64-MDCT technology. Emerg Radiol 16(6):433–440PubMedCrossRef
16.
Zurück zum Zitat Williams MD, Watts D, Fakhry S (2003) Colon injury after blunt abdominal trauma: results of the EAST Multi-Institutional Hollow Viscus Injury Study. J Trauma 55(5):906–912PubMedCrossRef Williams MD, Watts D, Fakhry S (2003) Colon injury after blunt abdominal trauma: results of the EAST Multi-Institutional Hollow Viscus Injury Study. J Trauma 55(5):906–912PubMedCrossRef
17.
Zurück zum Zitat Romano S, Scaglione M, Tortora G, Martino A, Di Pietto F, Romano L, Grassi R (2006) MDCT in blunt intestinal trauma. Eur J Radiol 59(3):359–366PubMedCrossRef Romano S, Scaglione M, Tortora G, Martino A, Di Pietto F, Romano L, Grassi R (2006) MDCT in blunt intestinal trauma. Eur J Radiol 59(3):359–366PubMedCrossRef
19.
Zurück zum Zitat Borgialli DA, Ellison AM, Ehrlich P, Bonsu B, Menaker J, Wisner DH, Atabaki S, Olsen CS, Sokolove PE, Lillis K, Kuppermann N, Holmes JF, For the Pediatric Emergency Care Applied Research Network (PECARN) (2014) Association between the seat belt sign and intra-abdominal injuries in children with blunt torso trauma in motor vehicle collisions. Acad Emerg Med 21(11):1240–1248. doi:10.1111/acem.12506 PubMedCrossRef Borgialli DA, Ellison AM, Ehrlich P, Bonsu B, Menaker J, Wisner DH, Atabaki S, Olsen CS, Sokolove PE, Lillis K, Kuppermann N, Holmes JF, For the Pediatric Emergency Care Applied Research Network (PECARN) (2014) Association between the seat belt sign and intra-abdominal injuries in children with blunt torso trauma in motor vehicle collisions. Acad Emerg Med 21(11):1240–1248. doi:10.​1111/​acem.​12506 PubMedCrossRef
22.
Zurück zum Zitat Klin B, Efrati Y, Vaiman M, Kozer E, Jeroukhimov I, Abu-Kishk I (2014) Abdominal injuries following bicycle-related blunt abdominal trauma in children. Minerva Pediatr. Nov 20 Klin B, Efrati Y, Vaiman M, Kozer E, Jeroukhimov I, Abu-Kishk I (2014) Abdominal injuries following bicycle-related blunt abdominal trauma in children. Minerva Pediatr. Nov 20
23.
Zurück zum Zitat Miller LA, Shanmuganathan K (2005) Multidetector CT evaluation of abdominal trauma. Radiol Clin North Am 43(6):1079–1095PubMedCrossRef Miller LA, Shanmuganathan K (2005) Multidetector CT evaluation of abdominal trauma. Radiol Clin North Am 43(6):1079–1095PubMedCrossRef
24.
Zurück zum Zitat Grassi R, Di Mizio R, Pinto A, Romano L, Rotondo A (2004) Serial plain abdominal film findings in the assessment of acute abdomen: spastic ileus, hypotonic ileus, mechanical ileus and paralytic ileus. Radiol Med 108:56–70PubMed Grassi R, Di Mizio R, Pinto A, Romano L, Rotondo A (2004) Serial plain abdominal film findings in the assessment of acute abdomen: spastic ileus, hypotonic ileus, mechanical ileus and paralytic ileus. Radiol Med 108:56–70PubMed
26.
Zurück zum Zitat Brofman N, Atri M, Hanson JM, Grinblat L, Chughtai T, Brenneman F (2006) Evaluation of bowel and mesenteric blunt trauma with multidetector CT. Radiographics 26:1119–1131PubMedCrossRef Brofman N, Atri M, Hanson JM, Grinblat L, Chughtai T, Brenneman F (2006) Evaluation of bowel and mesenteric blunt trauma with multidetector CT. Radiographics 26:1119–1131PubMedCrossRef
27.
Zurück zum Zitat Elton C, Riaz AA, Young N, Schamschula R, Papadopoulos B, Malka V (2005) Accuracy of computed tomography in the detection of blunt bowel and mesenteric injuries. Br J Surg 92:1024–1028PubMedCrossRef Elton C, Riaz AA, Young N, Schamschula R, Papadopoulos B, Malka V (2005) Accuracy of computed tomography in the detection of blunt bowel and mesenteric injuries. Br J Surg 92:1024–1028PubMedCrossRef
29.
Zurück zum Zitat Stuhlfaut JW, Anderson SW, Soto JA (2007) Blunt abdominal trauma: current imaging techniques and CT findings in patients with solid organ, bowel, and mesenteric injury. Semin Ultrasound CT MR 28(2):115–129PubMedCrossRef Stuhlfaut JW, Anderson SW, Soto JA (2007) Blunt abdominal trauma: current imaging techniques and CT findings in patients with solid organ, bowel, and mesenteric injury. Semin Ultrasound CT MR 28(2):115–129PubMedCrossRef
30.
Zurück zum Zitat Fang JF, Wong YC, Lin BC, Hsu YP, Chen MF (2006) Usefulness of multidetector computed tomography for the initial assessment of blunt abdominal trauma patients. World J Surg 30(2):176–182PubMedCrossRef Fang JF, Wong YC, Lin BC, Hsu YP, Chen MF (2006) Usefulness of multidetector computed tomography for the initial assessment of blunt abdominal trauma patients. World J Surg 30(2):176–182PubMedCrossRef
31.
Zurück zum Zitat Hanks PW, Brody JM (2003) Blunt injury to mesentery and small bowel: CT evaluation. Radiol Clin North Am 41(6):1171–1182PubMedCrossRef Hanks PW, Brody JM (2003) Blunt injury to mesentery and small bowel: CT evaluation. Radiol Clin North Am 41(6):1171–1182PubMedCrossRef
32.
Zurück zum Zitat Jacobs JE, Megibow AJ (2004) CT of GI trauma. Crit Rev Comput Tomogr 45(3):157–180 (corrected)PubMedCrossRef Jacobs JE, Megibow AJ (2004) CT of GI trauma. Crit Rev Comput Tomogr 45(3):157–180 (corrected)PubMedCrossRef
33.
Zurück zum Zitat Janzen DL, Zwirewich CV, Breen DJ, Nagy A (1998) Diagnostic accuracy of helical CT for detection of blunt bowel and mesenteric injuries. Clin Radiol 53(3):193–197PubMedCrossRef Janzen DL, Zwirewich CV, Breen DJ, Nagy A (1998) Diagnostic accuracy of helical CT for detection of blunt bowel and mesenteric injuries. Clin Radiol 53(3):193–197PubMedCrossRef
35.
36.
Zurück zum Zitat Shanmuganathan K (2004) Multi-detector row CT imaging of blunt abdominal trauma. Semin Ultrasound CT MR 25(2):180–204PubMedCrossRef Shanmuganathan K (2004) Multi-detector row CT imaging of blunt abdominal trauma. Semin Ultrasound CT MR 25(2):180–204PubMedCrossRef
37.
Zurück zum Zitat Soto JA, Anderson SW (2012) Multidetector CT of blunt abdominal trauma. Radiology 265(3):678–693PubMedCrossRef Soto JA, Anderson SW (2012) Multidetector CT of blunt abdominal trauma. Radiology 265(3):678–693PubMedCrossRef
38.
Zurück zum Zitat Pinto A, Magliocca M, Grassi R, Scaglione M, Romano L, Angelelli G (2001) [Role of computerized tomography in the diagnosis of peritoneo-intestinal lesions resulting from closed trauma. Experience at 2 emergency departments] Radiol Med 101(3):177–182 (Italian) Pinto A, Magliocca M, Grassi R, Scaglione M, Romano L, Angelelli G (2001) [Role of computerized tomography in the diagnosis of peritoneo-intestinal lesions resulting from closed trauma. Experience at 2 emergency departments] Radiol Med 101(3):177–182 (Italian)
39.
Zurück zum Zitat Wu CH, Wang LJ, Wong YC, Fang JF, Lin BC, Chen HW, Huang CC, Hung SC (2011) Contrast-enhanced multiphasic computed tomography for identifying life-threatening mesenteric hemorrhage and transmural bowel injuries. J Trauma 71(3):543–548. doi:10.1097/TA.0b013e3181fef15e PubMedCrossRef Wu CH, Wang LJ, Wong YC, Fang JF, Lin BC, Chen HW, Huang CC, Hung SC (2011) Contrast-enhanced multiphasic computed tomography for identifying life-threatening mesenteric hemorrhage and transmural bowel injuries. J Trauma 71(3):543–548. doi:10.​1097/​TA.​0b013e3181fef15e​ PubMedCrossRef
40.
Zurück zum Zitat Allen TL, Mueller MT, Bonk RT, Harker CP, Duffy OH, Stevens MH (2004) Computed tomographic scanning without oral contrast solution for blunt bowel and mesenteric injuries in abdominal trauma. J Trauma 56(2):314–322PubMedCrossRef Allen TL, Mueller MT, Bonk RT, Harker CP, Duffy OH, Stevens MH (2004) Computed tomographic scanning without oral contrast solution for blunt bowel and mesenteric injuries in abdominal trauma. J Trauma 56(2):314–322PubMedCrossRef
41.
Zurück zum Zitat Stuhlfaut JW, Soto JA, Lucey BC, Ulrich A, Rathlev NK, Burke PA, Hirsch EF (2004) Blunt abdominal trauma: performance of CT without oral contrast material. Radiology 233(3):689–694PubMedCrossRef Stuhlfaut JW, Soto JA, Lucey BC, Ulrich A, Rathlev NK, Burke PA, Hirsch EF (2004) Blunt abdominal trauma: performance of CT without oral contrast material. Radiology 233(3):689–694PubMedCrossRef
42.
Zurück zum Zitat Lee CH, Haaland B, Earnest A, Tan CH (2013) Use of positive oral contrast agents in abdominopelvic computed tomography for blunt abdominal injury: meta-analysis and systematic review. Eur Radiol 23(9):2513–2521. doi:10.1007/s00330-013-2860-8 PubMedCrossRef Lee CH, Haaland B, Earnest A, Tan CH (2013) Use of positive oral contrast agents in abdominopelvic computed tomography for blunt abdominal injury: meta-analysis and systematic review. Eur Radiol 23(9):2513–2521. doi:10.​1007/​s00330-013-2860-8 PubMedCrossRef
43.
Zurück zum Zitat Macari M, Balthazar EJ (2001) CT of bowel wall thickening: significance and pitfalls of interpretation. AJR Am J Roentgenol 176(5):1105–1116PubMedCrossRef Macari M, Balthazar EJ (2001) CT of bowel wall thickening: significance and pitfalls of interpretation. AJR Am J Roentgenol 176(5):1105–1116PubMedCrossRef
46.
Zurück zum Zitat Hawkins AE, Mirvis SE (2003) Evaluation of bowel and mesenteric injury: role of multidetector CT. Abdom Imaging 28(4):505–514PubMedCrossRef Hawkins AE, Mirvis SE (2003) Evaluation of bowel and mesenteric injury: role of multidetector CT. Abdom Imaging 28(4):505–514PubMedCrossRef
48.
Zurück zum Zitat Levine CD, Gonzales RN, Wachsberg RH, Ghanekar D (1997) CT findings of bowel and mesenteric injury. J Comput Assist Tomogr 21(6):974–979PubMedCrossRef Levine CD, Gonzales RN, Wachsberg RH, Ghanekar D (1997) CT findings of bowel and mesenteric injury. J Comput Assist Tomogr 21(6):974–979PubMedCrossRef
49.
Zurück zum Zitat Hefny AF, Kunhivalappil FT, Matev N, Avila NA, Bashir MO, Abu-Zidan FM (2014) Usefulness of free intraperitoneal air detected by CT scan in diagnosing bowel perforation in blunt trauma: experience from a community-based hospital. Injury. doi:10.1016/j.injury.2014.09.002 Hefny AF, Kunhivalappil FT, Matev N, Avila NA, Bashir MO, Abu-Zidan FM (2014) Usefulness of free intraperitoneal air detected by CT scan in diagnosing bowel perforation in blunt trauma: experience from a community-based hospital. Injury. doi:10.​1016/​j.​injury.​2014.​09.​002
50.
Zurück zum Zitat Sharma OP, Oswanski MF, Singer D, Kenney B (2004) The role of computed tomography in diagnosis of blunt intestinal and mesenteric trauma (BIMT). J Emerg Med 27(1):55–67PubMedCrossRef Sharma OP, Oswanski MF, Singer D, Kenney B (2004) The role of computed tomography in diagnosis of blunt intestinal and mesenteric trauma (BIMT). J Emerg Med 27(1):55–67PubMedCrossRef
52.
Zurück zum Zitat Rodriguez C, Barone JE, Wilbanks TO, Rha CK, Miller K (2002) Isolated free fluid on computed tomographic scan in blunt abdominal trauma: a systematic review of incidence and management. J Trauma 53(1):79–85PubMedCrossRef Rodriguez C, Barone JE, Wilbanks TO, Rha CK, Miller K (2002) Isolated free fluid on computed tomographic scan in blunt abdominal trauma: a systematic review of incidence and management. J Trauma 53(1):79–85PubMedCrossRef
54.
Zurück zum Zitat Lee SS, Park SH (2013) Computed tomography evaluation of gastrointestinal bleeding and acute mesenteric ischemia. Radiol Clin North Am 51(1):29–43PubMedCrossRef Lee SS, Park SH (2013) Computed tomography evaluation of gastrointestinal bleeding and acute mesenteric ischemia. Radiol Clin North Am 51(1):29–43PubMedCrossRef
55.
Zurück zum Zitat Brody JM, Leighton DB, Murphy BL, Abbott GF, Vaccaro JP, Jagminas L, Cioffi WG (2000) CT of blunt trauma bowel and mesenteric injury: typical findings and pitfalls in diagnosis. Radiographics 20(6):1525–1536PubMedCrossRef Brody JM, Leighton DB, Murphy BL, Abbott GF, Vaccaro JP, Jagminas L, Cioffi WG (2000) CT of blunt trauma bowel and mesenteric injury: typical findings and pitfalls in diagnosis. Radiographics 20(6):1525–1536PubMedCrossRef
56.
Zurück zum Zitat Mirvis SE, Shanmuganathan K, Erb R (1994) Diffuse small-bowel ischemia in hypotensive adults after blunt trauma (shock bowel): CT findings and clinical significance. AJR Am J Roentgenol 163(6):1375–1377PubMedCrossRef Mirvis SE, Shanmuganathan K, Erb R (1994) Diffuse small-bowel ischemia in hypotensive adults after blunt trauma (shock bowel): CT findings and clinical significance. AJR Am J Roentgenol 163(6):1375–1377PubMedCrossRef
58.
Zurück zum Zitat Fakhry SM, Watts DD, Luchette FA (2003) Current diagnostic approaches lack sensitivity in the diagnosis of perforated blunt small bowel injury: analysis from 275,557 trauma admissions from the EAST multi-institutional HVI trial. J Trauma 54(2):295–306PubMedCrossRef Fakhry SM, Watts DD, Luchette FA (2003) Current diagnostic approaches lack sensitivity in the diagnosis of perforated blunt small bowel injury: analysis from 275,557 trauma admissions from the EAST multi-institutional HVI trial. J Trauma 54(2):295–306PubMedCrossRef
Metadaten
Titel
Bowel and mesenteric injuries from blunt abdominal trauma: a review
verfasst von
Francesco Iaselli
Maria Antonietta Mazzei
Cristina Firetto
Domenico D’Elia
Nevada Cioffi Squitieri
Pietro Raimondo Biondetti
Francesco Maria Danza
Mariano Scaglione
Publikationsdatum
01.01.2015
Verlag
Springer Milan
Erschienen in
La radiologia medica / Ausgabe 1/2015
Print ISSN: 0033-8362
Elektronische ISSN: 1826-6983
DOI
https://doi.org/10.1007/s11547-014-0487-8

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