- 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
- Celiac and SMA Dissection: Facts
-Usually isolated finding but both vessels can be involved in up to 10% of cases
-Clinical presentation is persistent abdominal pain but most cases are incidental findings
-Treatment may be conservative (anticoagulation, analgesics and beta blockade)
-Intervention may be necessary with persistent symptoms, expansion of the false lumen or true lumen compromise - Splenic Artery Aneurysms: Etiologies
-Atherosclerosis
-Portal hypertension
-Hepatic transplant
-Pregnancy
-Collagen vascular disease
-Cirrhosis - Mesenteric Artery Aneurysms: Facts
-Most common artery is splenic artery (60%)
-Hepatic artery, SMA, celiac are the other common location in sequential order
- SMA Thrombosis: Facts
-SMA occlusion results in acute intestinal ischemia and infarction
-May be a result of thrombus from cardiac thrombus (50%), atrial fibrillation (40%)
-When acute thrombus usually in more distal portion of the SMA than proximal
- Celiac and SMA Stenosis: Etiology
-Atherosclerosis (older patients)
-Median arcuate ligament syndrome (younger patients)
-Tumor encasement (pancreatic cancer)
-Pancreatitis
- CT Angiography: Mesenteric Artery Evaluation: Protocols
-Phases required depend on the application with two phases usually necessary
-Contrast injection rate is 4-5 cc/sec with contrast volumes in the 80-120 cc volume range
-Contrast used is Omnipaque-350 or Visipaque-320 depending on the patients creatinine or GFR levels
-Arterial phase imaging is usually with a 25-30 second delay and nephrographic phase is at 55-60 seconds
- CT Angiography: Mesenteric Artery Evaluation
-Stenosis
-Median arcuate ligament syndrome
-Thrombus
-Aneurysm
-Pseudoaneurysm
-Dissection
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