may 28 – 30, 2015, montréal, québec imaging of bowel trauma
TRANSCRIPT
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May 28 – 30, 2015, Montréal, Québec
Imaging of Bowel Trauma
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Disclosure Statement: No Conflict of Interest
May 28 – 30, 2015, Montréal, Québec
.
I have no conflicts of interest to disclose ( i.e. no industry funding received or other commercial relationships).
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CT of Bowel and Mesenteric Injury
Sunnybrook HospitalRegional Trauma Centre
Dr. Paul Hamilton, University of TorontoCanadian Association of Radiologists, May 28, 2015
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Bowel and Mesenteric injury
• 1- 5% blunt trauma• Surgical intervention +++• Clinical exam limited• Interpretation difficult
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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
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Detection of significant bowel and mesenteric injuries in blunt abdominal trauma with 64-slice computed tomography
• 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.
Petrosoniak et al: Journal of Trauma and Acute Care Surgery: April 2013
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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
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Pseudo-pneumoperitoneum
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69 female, MVCPneumoperitoneum from chest, negative laparotomy
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22 year old man, GSW left flank
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25 year old man, stab woundLaparoscopy: no bowel injury
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39 man, ATV accident, free airIntraperitoneal bladder rupture
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Jejunal perforation66 year old woman, MVC
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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
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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)
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My Trauma Checklist
• 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)
Why these?
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37 woman, office injury
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SB mesenteric hematoma, non-therapeutic laparotomy
29 year old man, MVC
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Bowel and Mesenteric Injury…. Evaluation with CT
• Free fluid • Free air • Mesenteric infiltration • Bowel wall thickening • Mesenteric contrast
extravasation
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44 year old man, work accident, pinned by truck at loading dock
Differential bowel wall enhancement
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Bowel and Mesenteric Injury…. Evaluation with CT
• Free fluid • Free air • Mesenteric infiltration • Bowel wall thickening • Mesenteric contrast
extravasation• Differential BW
enhancement
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Differential bowel wall enhancement
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64 woman, MVCSigmoid colon discontinuity
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Bowel and Mesenteric Injury…. Evaluation with CT
• Free fluid • Free air • Mesenteric infiltration• Bowel wall thickening • Mesenteric vascular
extravasation• Differential
enhancement• Bowel wall
discontinuity
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34 year old cyclist hit by car
Non-therapeutic laparotomy
Shock bowel
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Hypovolemic shock complex• Bowel thickening,
dilatation, hyperenhancement
• Small vessels (IVC, Aorta)
• Retroperitoneal, mesenteric edema
• Abnormal organ perfusion
Ryan et al, Clinical Radiology, May, 2005
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Recommendations for CT bowel trauma
• free fluid
• use a checklist
• be aware of pitfalls