Hospital: H.U Puerto Real, H.U. Puerto Real, H.U.Puerto Real, H.U..Puerto Real.
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Aut@r o Autores: V. Lorenzo Quesada, J. Perez Herrera, M. Perez Benitez, A. Luna Morales, E.M. Garcia Gamez, C. Borrega Harinero.,
Presentación:
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.
Discusión:
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
Conclusión:
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
Bibliografía:
– 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