Imaging Pearls ❯ Small Bowel ❯ Trauma
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- “Duodenal trauma may result from penetrating or blunt injury. In blunt trauma, crushing of the duodenum against the vertebral body can cause contusion or transection especially of the second portion due to acute angulation and relative immobility in the retroperitoneum. Rapid deceleration in motor vehicle accidents is especially a risk factor for duodenal injury. Duodenal hematoma can result from blunt abdominal trauma and is classically seen in seat belt injury. Peritoneal signs are frequently absent on physical exam because of the retroperitoneal location of the duodenum.”
Duodenal emergencies: utility of multidetector CT with 2D multiplanar reconstructions for challenging but critical diagnoses
Polotsky M, Vadvala HV, Fishman EK, Johnson PT
Emergency Radiology https://doi.org/10.1007/s10140-019-01735-7
- “Duodenal trauma is rare, accounting for less than 2% of all abdominal trauma. Penetrating injury is the most common mechanism of duodenal injury, followed by blunt injury in the form of duodenal compression against the vertebral columns. CT is the imaging method of choice for assessment of duodenal trauma for many reasons, including nonspecific clinical presentation, frequently absence of peritoneal signs due to retroperitoneal location, and detection of associated injuries. Associated injuries include pancreatic, hepatic, renal, and splenic injuries, which are more common than isolated duodenal injury. Intramural hematoma, contusion, and perforation are the important spectral duodenal trauma.”
Imaging Spectrum of Non-neoplastic Duodenal Diseases Sitthipong S et al. Clinical Imaging (in press)
- “ The “panscan” (computed tomographic (CT) examination of the head, neck, chest, abdomen, and pelvis) has become an essential element in the early evaluation and decision making algorithm for hemodynamically stable patients who sustained abdominal trauma.”
Multidetector CT of Blunt Abdominal Trauma: State of the Art
Soto JA, Anderson SW
Radiology 2012;265:678-693 - “ In patients with hemoperitoneum, the presence of active extravasation and the rate of bleeding have a more direct effect on patient care decisions than does the volume of free fluid in the abdomen.”
Multidetector CT of Blunt Abdominal Trauma: State of the Art
Soto JA, Anderson SW
Radiology 2012;265:678-693 - Bowel and Mesenteric Trauma: facts
- Less than 5% of patients with severe abdominal trauma have bowel injuries
- Delays in diagnosis as short as 8-12 hours increase the rate of morbidity and mortality from peritonitis and sepsis
- Small bowel is involved in over 50% of cases and proximal jejunum and distal ileum most commonly involved - Bowel and Mesenteric Trauma: CT Findings
- Transection of the bowel wall with focal discontinuity
- Extraluminal oral contrast material
- Pneumoperitoneum
- Hematoma in bowel wall or mesentery
- Peritoneal extravasation of intravenous contrast enhanced blood
- Bowel wall thickening with or without abnormal enhancement - Pneumoperitoneum: Causes Beyond Bowel Perforation
- Intraperitoneal rupture of the bladder with foley catheter
- Massive pneumothorax
- Barotrauma
- Peritoneal lavage
- Benign pneumoperitoneum - Small Bowel Wall Trauma: Facts
- Focal bowel wall thickening especially when associated with fluid in adjacent mesentery is an important finding of trauma
- Diffuse bowel wall thickening may be due to the hypoperfusion complex (shock bowel)
- Mesenteric injuries can occur without bowel injury and can include active bleeding or injury to the mesenteric vessels - “ Multidetector CT technology offers unprecented imaging capabilities that can be readily applied for optimal evaluation of the polytrauma patient.”
Multidetector CT of Blunt Abdominal Trauma: State of the Art
Soto JA, Anderson SW
Radiology 2012;265:678-693 - “ However, to maximize the diagnostic potential of the examination and, at the same time, minimize risks, CT protocols need to be tailored to match the need of each individual patient.”
Multidetector CT of Blunt Abdominal Trauma: State of the Art
Soto JA, Anderson SW
Radiology 2012;265:678-693