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
| Autor: | Salomone Di Saverio, Andrea Biscardi, Francesco Cinquantini, Carlo Coniglio, Alice Piccinini, Giovanni Gordini, Gregorio Tugnoli, Sergio Mannone |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Contrast Media Abdominal Injuries Wounds Nonpenetrating Sensitivity and Specificity 030218 nuclear medicine & medical imaging Sepsis 03 medical and health sciences 0302 clinical medicine Blunt Predictive Value of Tests Laparotomy Multidetector Computed Tomography Humans Medicine Mesentery Radiology Nuclear Medicine and imaging Aged Retrospective Studies business.industry Gold standard Trauma center 030208 emergency & critical care medicine General Medicine Middle Aged medicine.disease Iopamidol Surgery Intestines Early Diagnosis Treatment Outcome Abdominal trauma Blunt trauma Female Radiology business Trauma surgery |
| Zdroj: | Canadian Association of Radiologists Journal. 68:276-285 |
| ISSN: | 1488-2361 0846-5371 |
| DOI: | 10.1016/j.carj.2016.07.003 |
| Popis: | Background and Aims 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. Materials and 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. |
| Databáze: | OpenAIRE |
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