49.11 Detection of Blunt Bowel and Mesenteric Injury Using Multidetector CT – Are We Getting Better?

Posted on January 26, 2017

R. Tayim1, E. Szymanski1, A. Gans1, A. Ekeh1  1Wright State University,Surgery,Dayton, OH, USA

Introduction:
The accurate detection of Blunt Bowel and Mesenteric Injuries (BBMI) remains a challenge, resulting in occasional delayed diagnosis.  CT imaging is the standard diagnostic modality used for the detection of BBMI. In many of the prior BBMI studies addressing missed injuries, lower resolution scanners were utilized. We sought to assess if our ability to diagnose BBMI and consequential missed injuries has improved with higher resolution CT.  

Methods:

All patients with small and large intestinal injuries as well as mesenteric injuries arising from blunt mechanisms, that were recognized in the operating room between January 2007 and January 2015, were identified utilizing the trauma registry at our ACS verified Level 1 Trauma Center. A 16-slice,multidetector, CT scanner was used exclusively during this time period. Patients under the age of 18, rectal injuries and simple serosal tears were excluded.

Results:
There were 116 patients identified with BBMI. Of these, 42 patients (36.2%) went directly to the Operating Room without CT imaging. Of the 74 patients who had CT imaging, definitive evidence ofBBMI was observed in 38 patients (51.4%) and evidence strongly indicating possible BBMI was seen in 31 patients (41.9%) – totalling 69 patients (93.2%). Evidence of BBMI on CT included free fluid without solid organ injury (40.6%), active mesenteric hemorrhage (24.6%), free intraperitoneal gas (20.3%), other mesenteric injury (18.9%), bowel swelling(14.5%), bowel hematoma (11.6%) and occult bowel injury (5.8%). 14 patients (18.9%) had delayed recognition of BBMI.

Conclusion:
The accurate diagnosis of BBMI remains a conundrum even in the era of higher resolution CT imaging. While the detection rate appears to have improved compared with prior studies, there is still a high rate of missed injuries. Free fluid without solid organ injuries continues to be the most prevalent finding. The search for the optimal diagnostic modality for BBMI continues.