Magu Sarita, Agarwal Shalini, Gill Ravinder Singh
Department of Radiodiagnosis, Pandit Bhagwat Dayal Sharma, Post Graduate Institute of Medical Sciences, Rohtak, 124001 Haryana India.
Indian J Surg. 2012 Dec;74(6):445-50. doi: 10.1007/s12262-011-0405-4. Epub 2012 Jan 25.
Bowel Injuries are uncommonly associated with traumatic abdominal injuries. However, they are associated with significant morbidity and mortality and require operative intervention unlike solid organ injuries. Hence, early diagnosis is of paramount importance. Computed tomographic (CT) scan is a well-established and highly accurate imaging modality for the detection of solid organ injury after blunt abdominal trauma. However, its role in diagnosing hollow viscus injury remains controversial. The aim of our study was to analyze the accuracy of multidetector CT (MDCT) in the diagnosis of bowel injury. Imaging features of surgically proven cases of bowel injury were identified over 8-year period (i.e., from January 2003 to December 2010) and were retrospectively analyzed. There were 32 patients with age range of 3-90 years. There was only one female. Sensitivity of various CT signs specific to bowel injury (i.e., extravasation of contrast and discontinuity of bowel wall) was 15.62, and 28.12%, respectively. While that of signs suggestive of bowel injury were pneumoperitoneum, 62.5%; gas in the vicinity, 40.62%; bowel wall hematoma, 21.87%; bowel wall thickening, 75%; ascites, 78.12%; mesenteric hematoma, 46.87%; and mesenteric stranding, 40.62%. Based on the major and minor signs, a diagnosis of bowel injury could be made in all patients except one. The minor signs showed a higher sensitivity than the major signs. Hence, we recommend that multidetector CT should be used as the modality of choice in case of patients with suspected bowel injury. We also suggest that the minor signs should be given as much importance as the major signs.
肠损伤与外伤性腹部损伤的关联并不常见。然而,它们会导致显著的发病率和死亡率,与实体器官损伤不同,需要手术干预。因此,早期诊断至关重要。计算机断层扫描(CT)是一种成熟且高度准确的成像方式,用于检测钝性腹部创伤后的实体器官损伤。然而,其在诊断中空脏器损伤方面的作用仍存在争议。我们研究的目的是分析多排螺旋CT(MDCT)诊断肠损伤的准确性。在8年期间(即2003年1月至2010年12月)识别出经手术证实的肠损伤病例的影像特征,并进行回顾性分析。有32例患者,年龄范围为3至90岁。仅有1名女性。各种特定于肠损伤的CT征象(即造影剂外渗和肠壁连续性中断)的敏感性分别为15.62%和28.12%。而提示肠损伤的征象中,气腹为62.5%;附近气体为40.62%;肠壁血肿为21.87%;肠壁增厚为75%;腹水为78.12%;肠系膜血肿为46.87%;肠系膜条索状影为40.62%。基于主要和次要征象,除1例患者外,所有患者均可诊断为肠损伤。次要征象的敏感性高于主要征象。因此,我们建议对于疑似肠损伤的患者,应将多排螺旋CT作为首选的检查方式。我们还建议次要征象应与主要征象给予同等重视。