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Evaluation of Bowel and Mesenteric Blunt Trauma with Multidetector CT¹

¹ From the Department of Medical Imaging (N.B., M.A., J.M.H., L.G.) and the Trauma Program (T.C., F.B.), Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5. Presented as an education exhibit at the 2004 RSNA Annual Meeting. Received July 14, 2005; revision requested November 4 and received January 3, 2006; accepted January 9. F.B. has received financial support from Ethicon Products, a division of Johnson & Johnson Medical, for speaking engagements at continuing medical education symposia. All other authors have no financial relationships to disclose. Address correspondence to M.A. (e-mail: mostafa.atri{at}sunnybrook.ca).

Bowel and mesenteric injuries are detected in 5% of blunt abdominal trauma patients at laparotomy. Computed tomography (CT) has been shown to be accurate for the diagnosis of bowel and mesenteric injuries and is the diagnostic test of choice in the evaluation of blunt abdominal trauma in hemodynamically stable patients. Specific CT findings of bowel and mesenteric injuries include bowel wall defect, intraperitoneal and mesenteric air, intraperitoneal extraluminal contrast material, extravasation of contrast material from mesenteric vessels, and evidence of bowel infarct. Specific signs of mesenteric injury are vascular beading and abrupt termination of mesenteric vessels. Less specific signs of bowel and mesenteric injuries include focal bowel wall thickening, mesenteric fat stranding with focal fluid and hematoma, and intraperitoneal or retroperitoneal fluid. When only nonspecific signs of bowel and mesenteric injuries are seen on CT images, correlation of CT features with clinical findings is necessary. A repeat CT examination after 6–8 hours if the patient’s condition is stable may help determine the significance of these nonspecific findings.

© RSNA, 2006

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