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

2. 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

3. 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

4. Bowel and Mesenteric injury
1- 5% blunt trauma
Surgical intervention +++
Clinical exam limited
Interpretation difficult

5. 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

6. 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.

7. 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

8. Pseudo-pneumoperitoneum

9. 69 female, MVC
Pneumoperitoneum from chest,
negative laparotomy

10. 22 year old man, GSW left flank

11. 25 year old man, stab wound
Laparoscopy: no bowel injury

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

13. Jejunal perforation
66 year old woman, MVC

14. 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

15. 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)

16. 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

17. 37 woman, office injury 17

18. SB mesenteric hematoma, non-therapeutic laparotomy
29 year old man, MVC

19. Bowel and Mesenteric Injury …. Evaluation with CT
Free fluid
Free air
Mesenteric infiltration
Bowel wall thickening
Mesenteric contrast extravasation

20. 44 year old man, work accident, pinned by truck at loading dock
Differential bowel wall enhancement

21. Bowel and Mesenteric Injury …. Evaluation with CT
Free fluid
Free air
Mesenteric infiltration
Bowel wall thickening
Mesenteric contrast extravasation
Differential BW enhancement

22. Differential bowel wall enhancement

23. 64 woman, MVC
Sigmoid colon discontinuity 23

24. Bowel and Mesenteric Injury …. Evaluation with CT
Free fluid
Free air
Mesenteric infiltration
Bowel wall thickening
Mesenteric vascular extravasation
Differential enhancement
Bowel wall discontinuity

25. 34 year old cyclist hit by car
Shock bowel
Non-therapeutic laparotomy

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

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