Imaging of Blunt Bowel, Mesenteric, and Body Wall Trauma
Introduction
Bowel injury is the third most commonly encountered injury following blunt abdominal trauma after injuries to the liver and spleen.1 Gallbladder injuries and traumatic abdominal wall hernias are seen more infrequently. However, less common, these injuries can carry significant morbidity and mortality if unrecognized. It is therefore important for the radiologist to maintain a high level of vigilance toward their detection and to alert the surgeon of any suspicious findings.
Section snippets
Patient Evaluation and Scanner Protocols
As with all traumas, accurate evaluation can be aided by obtaining detailed history with knowledge of the mechanism of injury. This underscores the importance of open communication between the trauma radiologist and the trauma and emergency services. Knowledge of any physical examination findings such as abdominal wall bruising in a seatbelt distribution (also known as the “seatbelt sign”) would clue the radiologist into potential intra-abdominal injury. If possible, the radiologist should also
General Features of Bowel and Mesenteric Injuries
Injury to the bowel occurs infrequently, with a reported incidence between 1% and 3% in patients with blunt trauma.1, 4 In patents who ultimately undergo exploratory laparotomy for blunt trauma, 5% reveal some degree of bowel injury.5 The presence of additional visceral injuries in the abdomen increases the likelihood of concomitant bowel injury. In patient with 3 or more solid organ injuries, the incidence of small bowel injury jumps to 34%.1
It is important to maintain a high level of
The Stomach
Gastric injuries are exceptionally rare following blunt trauma with an incidence of 0.06%.12 These patients are generally very ill. Injury to the stomach can result in rapid internal hemorrhage due to the rich vascular supply. These patients rapidly develop peritonitis indicating to the surgeon that a serious injury is present. A full-thickness tear of the stomach invariably results in pneumoperitoneum, and if large enough, the defect may be visible by CT (Fig. 6). American Association for the
Injuries to the Body Wall
Body wall hernias as a result of blunt abdominal trauma are rare. In a series of 22,891 patients, only 38 were identified yielding an incidence of 0.17% in that patient population.19 The injury was apparent on physical examination in less than half of these cases.19 Therefore, the radiologist׳s evaluation is an important opportunity to make this diagnosis.
The most common presentation is after motor vehicle collisions.19 In pediatrics, a lower abdominal traumatic hernia is often referred to as a
Conclusion
Although uncommon, injuries to the bowel, gallbladder, and abdominal wall typically require surgical intervention. Delayed diagnosis can result in increased morbidity and mortality. Unfortunately, highly specific signs of injury to these organs are not always seen. Therefore, the radiologist must relay the potential significance of any abnormal findings to the emergency physician or surgeon to guide appropriate management decisions about surgical management or close clinical monitoring.
Acknowledgments
The authors specially thanks to Dr Jennifer Uyeda for contributing cases for this publication.
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Cited by (1)
Abdominal Trauma
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