Sherck J, Shatney C, Sensaki K, Selivanov V
Department of Surgery, Santa Clara Valley Medical Center, San Jose, California 95128.
Am J Surg. 1994 Dec;168(6):670-5. doi: 10.1016/s0002-9610(05)80142-4.
Computed tomography (CT) is commonly used to evaluate patients with possible blunt intra-abdominal injury. One of its reported weaknesses is failure to demonstrate intestinal trauma. However, CT accuracy in identifying blunt small-bowel perforation has not been adequately assessed.
We tracked 883 consecutive stable trauma victims who had abdominal CT because of equivocal physical findings. Initial "wet reading" results were compared with laparotomy findings and patient outcome.
Small-bowel perforation occurred in 26 patients (3%). Twenty-four had CT abnormalities suggesting the injury. Twelve had CT findings considered diagnostic: contrast extravasation (n = 5) and/or extraluminal air (n = 11). One additional patient was thought to have free air on CT, but had no intestinal injury at laparotomy. Another 12 patients had CT scans that were non-diagnostic but suggestive: free fluid without solid organ injury (n = 10), or small-bowel thickening (n = 4) or dilatation (n = 3). Two patients with small-bowel injuries had normal CT scans. Of 857 patients without small-bowel disruption, 802 had normal abdominal CT scans, and 55 had 67 CT findings suggesting intestinal injury. Thus, CT diagnosed small-bowel perforation with a sensitivity of 92%, a specificity of 94%, and negative and positive predictive accuracies of 100% and 30%, respectively. The test had an overall accuracy (validity) of 94%.
Blunt small-bowel injury is uncommon. When it is present, abdominal CT is usually abnormal. CT findings in intestinal perforation can be subtle and nonspecific. Any unexplained abnormality on CT after blunt abdominal trauma may signal the presence of intestinal perforation and warrants close clinical observation or further diagnostic tests.
计算机断层扫描（CT）常用于评估可能存在钝性腹部损伤的患者。其报告的缺点之一是无法显示肠道创伤。然而，CT在识别钝性小肠穿孔方面的准确性尚未得到充分评估。
我们追踪了883例因体格检查结果不明确而接受腹部CT检查的连续稳定创伤患者。将最初的“初读”结果与剖腹手术结果及患者预后进行比较。
26例患者（3%）发生小肠穿孔。24例患者CT表现异常提示有损伤。12例患者的CT表现被认为具有诊断意义：造影剂外渗（n = 5）和/或腔外气体（n = 11）。另有1例患者CT上被认为有游离气体，但剖腹手术时无肠道损伤。另外12例患者的CT扫描结果无诊断意义但有提示作用：无实质性器官损伤的游离液体（n = 10），或小肠增厚（n = 4）或扩张（n = 3）。2例小肠损伤患者CT扫描结果正常。在857例无小肠破裂的患者中，802例腹部CT扫描结果正常，55例有67项CT表现提示肠道损伤。因此，CT诊断小肠穿孔的敏感性为92%，特异性为94%，阴性和阳性预测准确率分别为100%和30%。该检查的总体准确率（有效性）为94%。
钝性小肠损伤并不常见。当存在时，腹部CT通常会出现异常。肠道穿孔的CT表现可能很细微且不具特异性。钝性腹部创伤后CT上任何无法解释的异常可能提示存在肠道穿孔，需要密切临床观察或进一步的诊断检查。
