Skip to main content
SpringerLink
Log in

Peritoneal fluid of low CT Hounsfield units as a screening criterion for traumatic bowel perforation

  • Original Article
  • Published:
Japanese Journal of Radiology Aims and scope Submit manuscript

Abstract

Purpose

To investigate whether peritoneal fluid of low CT Hounsfield units is an important screening criterion for traumatic bowel perforation.

Materials and methods

We performed a retrospective study on two cohorts of blunt trauma patients who had peritoneal fluid. Intravenous and oral contrast was used for the first cohort (61 patients) as opposed to intravenous contrast only for the second cohort (60 patients). We compared the CT Hounsfield units of peritoneal fluid with bowel perforation. The optimal cutoff value of CT Hounsfield units was determined, and its diagnostic values for bowel perforation were calculated.

Results

The mean CT Hounsfield units (HU) of peritoneal fluid with bowel perforation were significantly lower (30.3 ± 9.0 versus 44.1 ± 13.6 HU, p = 0.008) in the second cohort. The optimal cutoff value was 43 HU, and its sensitivity, specificity, accuracy and positive likelihood ratio were 100.0, 69.2, 73.3% and 3.3, respectively, for bowel perforation. Comparisons of CT HUs of peritoneal fluid with bowel perforation in the first cohort that used additional oral contrast for CT did not show statistically significant differences.

Conclusion

Peritoneal fluid of low CT HU is a sensitive and important CT screening criterion for traumatic bowel perforation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Watts DD, Fakhry SM. Incidence of hollow viscus injury in blunt trauma: an analysis from 275,557 trauma admissions from the East multi-institutional trial. J Trauma. 2003;54:289–94.

    Article  PubMed  Google Scholar 

  2. Brofman N, Atri M, Hanson JM, Grinblat L, Chughtai T, Brenneman F. Evaluation of bowel and mesenteric blunt trauma with multidetector CT. Radiographics. 2006;26:1119–31.

    Article  PubMed  Google Scholar 

  3. LeBedis CA, Anderson SW, Soto JA. CT imaging of blunt traumatic bowel and mesenteric injuries. Radiol Clin North Am. 2012;50:123–36.

    Article  PubMed  Google Scholar 

  4. Wu CH, Wang LJ, Wong YC, et al. Contrast-enhanced multiphasic computed tomography for identifying life-threatening mesenteric hemorrhage and transmural bowel injuries. J Trauma. 2011;71:543–8.

    Article  PubMed  Google Scholar 

  5. Butela ST, Federle MP, Chang PJ, et al. Performance of CT in detection of bowel injury. AJR Am J Roentgenol. 2001;176:129–35.

    Article  CAS  PubMed  Google Scholar 

  6. Ekeh AP, Saxe J, Walusimbi M, et al. Diagnosis of blunt intestinal and mesenteric injury in the era of multidetector CT technology—are results better? J Trauma. 2008;65:354–9.

    Article  PubMed  Google Scholar 

  7. Atri M, Hanson JM, Grinblat L, Brofman N, Chughtai T, Tomlinson G. Surgically important bowel and/or mesenteric injury in blunt trauma: accuracy of multidetector CT for evaluation. Radiology. 2008;249:524–33.

    Article  PubMed  Google Scholar 

  8. Peters E, LoSasso B, Foley J, Rodarte A, Duthie S, Senac MO Jr. Blunt bowel and mesenteric injuries in children: do nonspecific computed tomography findings reliably identify these injuries? Pediatr Crit Care Med. 2006;7:551–6.

    Article  PubMed  Google Scholar 

  9. Stuhlfaut JW, Soto JA, Lucey BC, et al. Blunt abdominal trauma: performance of CT without oral contrast material. Radiology. 2004;233:689–94.

    Article  PubMed  Google Scholar 

  10. Killeen KL, Shanmuganathan K, Poletti PA, Cooper C, Mirvis SE. Helical computed tomography of bowel and mesenteric injuries. J Trauma. 2001;51:26–36.

    Article  CAS  PubMed  Google Scholar 

  11. Yu J, Fulcher AS, Wang DB, et al. Frequency and importance of small amount of isolated pelvic free fluid detected with multidetector CT in male patients with blunt trauma. Radiology. 2010;256:799–805.

    Article  PubMed  Google Scholar 

  12. Saku M, Yoshimitsu K, Murakami J, et al. Small bowel perforation resulting from blunt abdominal trauma: interval change of radiological characteristics. Radiat Med. 2006;24:358–64.

    Article  PubMed  Google Scholar 

  13. Levine CD, Patel UJ, Silverman PM, Wachsberg RH. Low attenuation of acute traumatic hemoperitoneum on CT scans. AJR Am J Roentgenol. 1996;166:1089–93.

    Article  CAS  PubMed  Google Scholar 

  14. Kim HC, Shin HC, Park SJ, et al. Traumatic bowel perforation: analysis of CT findings according to the perforation site and the elapsed time since accident. Clin Imaging. 2004;28:334–9.

    Article  PubMed  Google Scholar 

  15. Drasin TE, Anderson SW, Asandra A, Rhea JT, Soto JA. MDCT evaluation of blunt abdominal trauma: clinical significance of free intraperitoneal fluid in males with absence of identifiable injury. AJR Am J Roentgenol. 2008;191:1821–6.

    Article  PubMed  Google Scholar 

  16. Hulka F, Mullins RJ, Leonardo V, Harrison MW, Silberberg P. Significance of peritoneal fluid as an isolated finding on abdominal computed tomographic scans in pediatric trauma patients. J Trauma. 1998;44:1069–72.

    Article  CAS  PubMed  Google Scholar 

  17. Lafferty B. Oral contrast omission in the computed tomographic evaluation of blunt abdominal trauma: a literature review. J Trauma Nurs Off J Soc Trauma Nurses. 2012;19:E1–4.

    Article  Google Scholar 

  18. Stuhlfaut JW, Anderson SW, Soto JA. Blunt abdominal trauma: current imaging techniques and CT findings in patients with solid organ, bowel, and mesenteric injury. Semin Ultrasound CT MR. 2007;28:115–29.

    Article  PubMed  Google Scholar 

  19. Allen TL, Mueller MT, Bonk RT, Harker CP, Duffy OH, Stevens MH. Computed tomographic scanning without oral contrast solution for blunt bowel and mesenteric injuries in abdominal trauma. J Trauma. 2004;56:314–22.

    Article  PubMed  Google Scholar 

  20. Fakhry SM, Brownstein M, Watts DD, Baker CC, Oller D. 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. 2000;48:408–14 (discussion 414–405).

    Article  CAS  PubMed  Google Scholar 

  21. Cunningham MA, Tyroch AH, Kaups KL, Davis JW. Does free fluid on abdominal computed tomographic scan after blunt trauma require laparotomy? J Trauma. 1998;44:599–602 (discussion 603).

    Article  CAS  PubMed  Google Scholar 

  22. Levine CD, Patel UJ, Wachsberg RH, Simmons MZ, Baker SR, Cho KC. CT in patients with blunt abdominal trauma: clinical significance of intraperitoneal fluid detected on a scan with otherwise normal findings. AJR Am J Roentgenol. 1995;164:1381–5.

    Article  CAS  PubMed  Google Scholar 

  23. Brasel KJ, Olson CJ, Stafford RE, Johnson TJ. Incidence and significance of free fluid on abdominal computed tomographic scan in blunt trauma. J Trauma. 1998;44:889–92.

    Article  CAS  PubMed  Google Scholar 

  24. Eanniello VC 2nd, Gabram SG, Eusebio R, Jacobs LM. Isolated free fluid on abdominal computerized tomographic scan: an indication for surgery in blunt trauma patients? Conn Med. 1994;58:707–10.

    PubMed  Google Scholar 

  25. Venkatesh KR, McQuay N Jr. Outcomes of management in stable children with intra-abdominal free fluid without solid organ injury after blunt abdominal injury. J Trauma. 2007;62:216–20.

    Article  PubMed  Google Scholar 

  26. Ryan MF, Hamilton PA, Sarrazin J, Chu P, Benjaminov O, Lam K. The halo sign and peripancreatic fluid: useful CT signs of hypovolaemic shock complex in adults. Clin Radiol. 2005;60:599–607.

    Article  CAS  PubMed  Google Scholar 

  27. Ames JT, Federle MP. CT hypotension complex (shock bowel) is not always due to traumatic hypovolemic shock. AJR Am J Roentgenol. 2009;192:W230–5.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study was partly supported by research grants from the National Science Council, Taiwan (NSC 93-2314-B-182A-093 and NSC 95-2314-B-182A-198).

Author information

Authors and Affiliations

  1. Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, 5 Fu-Hsing Street, Gueishan, Taoyuan, 33333, Taiwan

    Yon-Cheong Wong, Li-Jen Wang, Cheng-Hsien Wu & Huan-Wu Chen

  2. Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Gueishan, Taoyuan, Taiwan

    Being-Chuan Lin & Yu-Pao Hsu

Authors
  1. Yon-Cheong Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Li-Jen Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cheng-Hsien Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Huan-Wu Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Being-Chuan Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yu-Pao Hsu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yon-Cheong Wong.

Ethics declarations

Conflict of interest

Yon-Cheong Wong received research grants from the National Science Council, Taiwan (less than 2,000,000 yen). The other authors declare that they have no conflict of interest.

IRB approval

This study was approved by the IRB of our institution (Re: 101-4636B).

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wong, YC., Wang, LJ., Wu, CH. et al. Peritoneal fluid of low CT Hounsfield units as a screening criterion for traumatic bowel perforation. Jpn J Radiol 35, 145–150 (2017). https://doi.org/10.1007/s11604-017-0613-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11604-017-0613-3

Keywords

Search

Navigation