Small-Bowel and Mesenteric Injuries in Blunt Trauma of the Abdomen

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Presentation transcript:

Small-Bowel and Mesenteric Injuries in Blunt Trauma of the Abdomen Vivek Virmani, MD, DNB, FRCR, Uttam George, MD, DNB, Blair MacDonald, MD, FRCPC, Adnan Sheikh, MD Canadian Association of Radiologists Journal Volume 64, Issue 2, Pages 140-147 (May 2013) DOI: 10.1016/j.carj.2012.10.001 Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

Figure 1 Bowel perforation at the ligament of Treitz in a 55-year-old woman after a motor vehicle accident. (A, B) Axial computed tomography image, showing a suspicious defect (white arrow) with focal fluid and extraluminal air (arrowhead) adjacent to the duodenojejunal junction. There also is free pneumoperitoneum (black arrows). There is a posttraumatic jejunojejunal intussusception (dashed arrow). The patient later underwent resection of a 9-cm segment of the small bowel and manual reduction of the intussusception. Canadian Association of Radiologists Journal 2013 64, 140-147DOI: (10.1016/j.carj.2012.10.001) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

Figure 2 Splenic lacerations and ileal perforation in a 66-year-old woman involved in a motor vehicle injury. (A) Axial contrast-enhanced computed tomography (CT), revealing multiple large splenic lacerations (arrows) with hemoperitoneum (arrowheads). (B, C) Caudal CT sections, revealing an ileal loop perforation (arrow in B) with free extraluminal air (arrowhead in C). There is a large hemoperitoneum. Canadian Association of Radiologists Journal 2013 64, 140-147DOI: (10.1016/j.carj.2012.10.001) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

Figure 3 An 18-year-old woman with seat-belt injury in a motor vehicle accident. (A) Axial contrast computed tomography (CT), revealing complete transection of the neck of the pancreas (arrow). (B) Caudal CT section, revealing a complete transection at the junction of the D2 and D3 segments of the duodenum (white arrows) with associated duodenal-wall thickening and hematoma (black arrow). There also is a traumatic right lateral abdominal-wall hernia through the diaphragmatic insertion with the hepatic flexure seen in the hernial sac (arrowhead). There is fluid adjacent to the hepatic flexure, and intraoperative findings revealed bruised but otherwise intact colon. (C) Sagittal CT, demonstrating fracture dislocation at L1-L2 level (arrow). Canadian Association of Radiologists Journal 2013 64, 140-147DOI: (10.1016/j.carj.2012.10.001) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

Figure 4 Shock bowel in a 28-year-old man involved in a motor vehicle accident. (A) Axial- and (B) coronal-contrast computed tomography, revealing diffuse wall thickening and increased mural enhancement of the small-bowel mucosa (white arrows). The collapsed inferior vena cava (dashed arrow), narrow calibre aorta (black arrow), and dense renal cortical enhancement (arrowheads) are the other features of hypovolemic shock complex. Canadian Association of Radiologists Journal 2013 64, 140-147DOI: (10.1016/j.carj.2012.10.001) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

Figure 5 Another case of shock bowel with thickened, hyperemic, and fluid-filled bowel loops (circled). Canadian Association of Radiologists Journal 2013 64, 140-147DOI: (10.1016/j.carj.2012.10.001) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

Figure 6 Gastric-wall hematoma in a 28-year-old man with blunt trauma to the abdomen. Contrast-enhanced computed tomography, revealing high-density soft tissue along the anterior gastric wall (arrow). The patient was treated conservatively, and the hematoma subsequently resolved. Canadian Association of Radiologists Journal 2013 64, 140-147DOI: (10.1016/j.carj.2012.10.001) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

Figure 7 A 39-year-old woman with a seat-belt injury from a motor vehicle accident, with focal devascularization of the small bowel. (A) Axial- and (B) coronal-contrast computed tomography, revealing a focal, nonenhancing, 8-cm-long ileal loop (arrows). No extraluminal air or fluid was seen. Operative findings demonstrated shearing of mesentery from this segment of the small bowel, with resultant ischemia. Canadian Association of Radiologists Journal 2013 64, 140-147DOI: (10.1016/j.carj.2012.10.001) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

Figure 8 A 31-year-old woman involved in a motor vehicle accident, with active arterial mesenteric bleed. (A, B) Axial-contrast computed tomography, revealing extravasation of contrast (arrows) with a tear in the mesentery (dashed arrow). Operative findings revealed an actively bleeding mesenteric defect approximately 1 m (3 ft) from the ileocecal valve. Canadian Association of Radiologists Journal 2013 64, 140-147DOI: (10.1016/j.carj.2012.10.001) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

Figure 9 Isolated superior mesenteric artery (SMA) dissection in a 45-year-old man involved in a motor vehicle accident who presented with acute epigastric pain. (A, B) Axial contrast-enhanced computed tomography, revealing thrombus in the false lumen (arrow), which is compressing the true lumen (arrowhead). (C) Distal to the thrombus, an intimal flap (arrow) is identified approximately 3 cm from the origin of the SMA. Distal blood flow was preserved, with no bowel infarction. Canadian Association of Radiologists Journal 2013 64, 140-147DOI: (10.1016/j.carj.2012.10.001) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

Figure 10 An omental vascular injury in a 35-year-old man involved in a motor vehicle accident. Contrast-enhanced computed tomography, revealing an omental hematoma (arrow), with active extravasation of contrast (arrowhead). Hemoperitoneum also is present (dashed arrow). Canadian Association of Radiologists Journal 2013 64, 140-147DOI: (10.1016/j.carj.2012.10.001) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

Figure 11 Traumatic left diaphragmatic hernia in a 39-year-old woman involved in a motor vehicle accident. (A) Axial- and (B) coronal-contrast–enhanced computed tomography, revealing a left diaphragmatic hernia with stomach (dashed arrows) and small-bowel loops in the hernial sac. There is discontinuity of the left hemidiaphragm (arrow), and the small-bowel loops are lying dependent against the left posterior ribs (“dependent viscera sign”) (arrowhead). There is traumatic chest-wall emphysema (star). Canadian Association of Radiologists Journal 2013 64, 140-147DOI: (10.1016/j.carj.2012.10.001) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

Figure 12 Multiple enteroenteric intussusceptions in a 45-year-old man with blunt trauma to the abdomen. (A) Axial- and (B) coronal-contrast computed tomography, revealing multiple jejunojejunal intussusceptions (arrows). There is hemoperitoneum (arrowhead) related to the trauma. Canadian Association of Radiologists Journal 2013 64, 140-147DOI: (10.1016/j.carj.2012.10.001) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

Figure 13 Acute appendicitis in a 34-year-old man involved in a street fight, with severe blunt trauma to the right lower quadrant. (A, B) Axial-contrast computed tomography, revealing a prominent appendix (solid arrow) with periappendiceal stranding (broken arrow). Canadian Association of Radiologists Journal 2013 64, 140-147DOI: (10.1016/j.carj.2012.10.001) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions