Hospital: H.U Puerto Real, H.U. Puerto Real, H.U.Puerto Real, H.U..Puerto Real.
Aut@r o Autores: V. Lorenzo Quesada, J. Perez Herrera, M. Perez Benitez, A. Luna Morales, E.M. Garcia Gamez, C. Borrega Harinero.
89 year old woman involved in road traffic accident. Abdominal pain. CT findings: - Active extravasation of contrast media from mesenteric vessels. - Mesenteric infiltration: haziness and fat stranding. - Mesenteric hematoma, haemoperotoneum. - Accumulation ('pooling') of contrast on multiphase imaging. -Intrayejunal hematoma. - Liver laceration.
The bowel and mesentery are injured in ~2.5% (range 0.3-5%) of blunt force abdominal trauma Gunshot wounds (~75%) and stabbings (~20%) are the leading causes of bowel and mesenteric injury from penetrating trauma. Motor vehicle collisions are the most common cause of blunt trauma followed by falls, assaults and sports-related trauma. Mesenteric injuries can include: - active bleeding from a laceration - mesenteric hematoma Diagnosis - Definitive signs: - Active extravasation of contrast media indicative of active bleeding and a significant mesenteric injury.The sign has a specificity of 100% for the diagnosis ofsignificant mesenteric injuries, but it was seen in only 17% of patient with bowel and mesenteric injuries. - Intermesenteric free fluid, often forming triangles - Beading and termination of mesenteric vessels - Abrupt termination of the mesenteric vessels - Accumulation ('pooling') of contrast on multiphase imaging - suggestive signs - Mesenteric infiltration: haziness and fat stranding - Mesenteric hematoma - Bowel wall thickening Treatment and prognosis Even with increasing non-operative management of traumatic abdominal organs (e.g.liver or spleen laceration), traumatic bowel and mesenteric injuries such as perforation or active mesenteric bleeding still require operative management
CT is sensitive in the identification of bowel and mesenteric injury after blunt trauma providing a wide spectrum of findings. Persistent, active extravasation of intravenous contrast medium from the mesenteric vessels, in isolation or associated with further injuries, requires immediate exploration and repair. Close clinical observation, monitoring, and surgical expertise are mandatory for appropiate management.
- Nicole Brofman, MD Mostafa Atri, MD, Dip Epid ? John M. Hanson,MBBCh Evaluation of Bowel and Mesenteric Blunt Trauma with Multidetector CT, RadioGraphics 2006.1119-1131 - Jeffrey M. Brody, MD • Danielle B. Leighton, MD • Brian L. Murphy, MD •CT of Blu