Firetto Maria Cristina, Sala Francesco, Petrini Marcello, Lemos Alessandro A, Canini Tiberio, Magnone Stefano, Fornoni Gianluca, Cortinovis Ivan, Sironi Sandro, Biondetti Pietro R
Department of Radiology, Ca' Granda IRCSS Maggiore Policlinico Hospital Foundation Trust, Via Francesco Sforza 35, 20122, Milan, Italy.
Department of Radiology, Pope John XXIII Hospital, University of Milan Bicocca, Piazza O.M.S 1, 24127, Bergamo, Italy.
Emerg Radiol. 2018 Oct;25(5):461-467. doi: 10.1007/s10140-018-1608-9. Epub 2018 Apr 27.
Bowel and/or mesentery injuries represent the third most common injury among patients with blunt abdominal trauma. Delayed diagnosis increases morbidity and mortality. The aim of our study was to evaluate the role of clinical signs along with CT findings as predictors of early surgical repair.
Between March 2014 and February 2017, charts and CT scans of consecutive patients treated for blunt abdominal trauma in two different trauma centers were reread by two experienced radiologists. We included all adult patients who underwent contrast-enhanced CT of the abdomen and pelvis with CT findings of blunt bowel and/or mesenteric injury (BBMI). We divided CT findings into two groups: the first included three highly specific CT signs and the second included six less specific CT signs indicated as "minor CT findings." The presence of abdominal guarding and/or abdominal pain was considered as "clinical signs." Reference standards included surgically proven BBMI and clinical follow-up. Association was evaluated by the chi-square test. A logistic regression model was used to estimate odds ratio (OR) and confidence intervals (CI).
Thirty-four (4.1%) out of 831 patients who sustained blunt abdominal trauma had BBMI at CT. Twenty-one out of thirty-four patients (61.8%) underwent surgical repair; the remaining 13 were treated conservatively. Free fluid had a significant statistical association with surgery (p = 0.0044). The presence of three or more minor CT findings was statistically associated with surgery (OR = 8.1; 95% CI, 1.2-53.7). Abdominal guarding along with bowel wall discontinuity and extraluminal air had the highest positive predictive value (100 and 83.3%, respectively).
In patients without solid organ injury (SOI), the presence of free fluid along with abdominal guarding and three or more "minor CT findings" is a significant predictor of early surgical repair. The association of bowel wall discontinuity with extraluminal air warrants exploratory laparotomy.
肠和/或肠系膜损伤是钝性腹部创伤患者中第三常见的损伤。延迟诊断会增加发病率和死亡率。我们研究的目的是评估临床体征以及CT表现作为早期手术修复预测指标的作用。
在2014年3月至2017年2月期间，两名经验丰富的放射科医生重新阅读了两个不同创伤中心接受钝性腹部创伤治疗的连续患者的病历和CT扫描图像。我们纳入了所有接受腹部和盆腔增强CT检查且CT表现为钝性肠和/或肠系膜损伤（BBMI）的成年患者。我们将CT表现分为两组：第一组包括三个高度特异的CT征象，第二组包括六个特异性较低的CT征象，称为“轻微CT表现”。腹部压痛和/或腹痛的存在被视为“临床体征”。参考标准包括手术证实的BBMI和临床随访。通过卡方检验评估相关性。使用逻辑回归模型估计比值比（OR）和置信区间（CI）。
831例钝性腹部创伤患者中，34例（4.1%）CT检查发现有BBMI。34例患者中有21例（61.8%）接受了手术修复；其余13例接受保守治疗。腹腔游离液体与手术有显著统计学关联（p = 0.0044）。三个或更多轻微CT表现的存在与手术有统计学关联（OR = 8.1；95%CI，1.2 - 53.7）。腹部压痛伴肠壁连续性中断和肠腔外气体具有最高的阳性预测值（分别为100%和83.3%）。
在没有实质脏器损伤（SOI）的患者中，腹腔游离液体伴腹部压痛和三个或更多“轻微CT表现”是早期手术修复的重要预测指标。肠壁连续性中断与肠腔外气体的关联值得进行剖腹探查。
