Imaging of Bowel Trauma

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Presentation transcript:

Imaging of Bowel Trauma May 28 – 30, 2015, Montréal, Québec

Disclosure Statement: No Conflict of Interest . I have no conflicts of interest to disclose ( i.e. no industry funding received or other commercial relationships). May 28 – 30, 2015, Montréal, Québec

CT of Bowel and Mesenteric Injury Dr. Paul Hamilton, University of Toronto Canadian Association of Radiologists, May 28, 2015 Sunnybrook Hospital Regional Trauma Centre 3

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

68 patients laparotomy proven blunt bowel and mesenteric injuries. Detection of significant bowel and mesenteric injuries in blunt abdominal trauma with 64-slice computed tomography Petrosoniak et al: Journal of Trauma and Acute Care Surgery: April 2013 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.

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, MVC Pneumoperitoneum from chest, negative laparotomy

22 year old man, GSW left flank

25 year old man, stab wound Laparoscopy: no bowel injury

39 man, ATV accident, free air Intraperitoneal bladder rupture 12

Jejunal perforation 66 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 Why these? 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) 16

37 woman, office injury 17

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, MVC Sigmoid colon discontinuity 23

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 Shock bowel Non-therapeutic laparotomy

Hypovolemic shock complex Ryan et al, Clinical Radiology, May, 2005 Bowel thickening, dilatation, hyperenhancement Small vessels (IVC, Aorta) Retroperitoneal, mesenteric edema Abnormal organ perfusion

Recommendations for CT bowel trauma free fluid use a checklist be aware of pitfalls