may 28 – 30, 2015, montréal, québec imaging of bowel trauma
TRANSCRIPT
May 28 – 30, 2015, Montréal, Québec
Imaging of Bowel Trauma
Disclosure Statement: No Conflict of Interest
May 28 – 30, 2015, Montréal, Québec
.
I have no conflicts of interest to disclose ( i.e. no industry funding received or other commercial relationships).
CT of Bowel and Mesenteric Injury
Sunnybrook HospitalRegional Trauma Centre
Dr. Paul Hamilton, University of TorontoCanadian Association of Radiologists, May 28, 2015
Bowel and Mesenteric injury
• 1- 5% blunt trauma• Surgical intervention +++• Clinical exam limited• Interpretation difficult
Bowel and Mesenteric Injury…. Evaluation with CT
• Free fluid (96%)• Free air (32%)• Mesenteric infiltration
(86%)• Bowel wall thickening
(61%)
Rizzo et al. Radiology 1989
Detection of significant bowel and mesenteric injuries in blunt abdominal trauma with 64-slice computed tomography
• 68 patients laparotomy proven blunt bowel and mesenteric injuries.
• all had free fluid.• 4 cases minimal ff without additional
findings.• Conclusions: No FF makes
bowel/mesenteric injury unlikely • Even minimal ff remains relevant.
Petrosoniak et al: Journal of Trauma and Acute Care Surgery: April 2013
Bowel and Mesenteric Injury…. Evaluation with CT
• Free fluid (96%)• Free air (32%)• Mesenteric infiltration
(86%)• Bowel wall thickening
(61%)
Rizzo et al. Radiology 1989
Oral contrast
Pseudo-pneumoperitoneum
69 female, MVCPneumoperitoneum from chest, negative laparotomy
22 year old man, GSW left flank
25 year old man, stab woundLaparoscopy: no bowel injury
39 man, ATV accident, free airIntraperitoneal bladder rupture
Jejunal perforation66 year old woman, MVC
Bowel and Mesenteric Injury…. Evaluation with CT
• Free fluid (96%)• Free air (32%)• Mesenteric infiltration
(86%)• Bowel wall thickening
(61%)
Rizzo et al. Radiology 1989
My Trauma Checklist
• 1. free air• 2. diaphragm• 3. mesenteric hematoma/fluid• 4. extravasation• 5. differential bowel wall enhancement
(You can make you own list)
My Trauma Checklist
• 1. free air – (bowel perforation/surgery)• 2. diaphragm – (surgical repair)• 3. mesenteric hematoma/fluid –
(bowel/mesenteric injury/surgery)• 4. extravasation – (intervention)• 5. dif. bowel wall enhancement -
(surgery)
Why these?
37 woman, office injury
SB mesenteric hematoma, non-therapeutic laparotomy
29 year old man, MVC
Bowel and Mesenteric Injury…. Evaluation with CT
• Free fluid • Free air • Mesenteric infiltration • Bowel wall thickening • Mesenteric contrast
extravasation
44 year old man, work accident, pinned by truck at loading dock
Differential bowel wall enhancement
Bowel and Mesenteric Injury…. Evaluation with CT
• Free fluid • Free air • Mesenteric infiltration • Bowel wall thickening • Mesenteric contrast
extravasation• Differential BW
enhancement
Differential bowel wall enhancement
64 woman, MVCSigmoid colon discontinuity
Bowel and Mesenteric Injury…. Evaluation with CT
• Free fluid • Free air • Mesenteric infiltration• Bowel wall thickening • Mesenteric vascular
extravasation• Differential
enhancement• Bowel wall
discontinuity
34 year old cyclist hit by car
Non-therapeutic laparotomy
Shock bowel
Hypovolemic shock complex• Bowel thickening,
dilatation, hyperenhancement
• Small vessels (IVC, Aorta)
• Retroperitoneal, mesenteric edema
• Abnormal organ perfusion
Ryan et al, Clinical Radiology, May, 2005
Recommendations for CT bowel trauma
• free fluid
• use a checklist
• be aware of pitfalls