Article

Traumatic bowel perforation: analysis of CT findings according to the perforation site and the elapsed time since accident.

Department of Diagnostic Radiology, Soonchunhyang University, Cheonan Hospital, 23-20 Bongmyeong-Dong, Cheonan-Si, Chungcheongnam 330-721, Republic of Korea.
Clinical Imaging (Impact Factor: 0.65). 28(5):334-9. DOI: 10.1016/S0899-7071(03)00244-4
Source: PubMed

ABSTRACT Abdominal CTs of 57 patients with bowel perforation after blunt abdominal trauma were retrospectively analyzed to determine: the diagnostic accuracy of the perforation site, and the differential findings according to the elapsed time from the trauma. Diagnostic accuracy of the perforation site was as follows: duodenum (100%), jejunum (81%), jejunoileal junction (100%), ileum (93%), and colon (20%). Extraluminal air was the only significant differential findings according to the elapsed time, and was seen more commonly on late stage of bowel perforation (P<.05).

0 Bookmarks
 · 
67 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: The objective was to assess the diagnostic performance of 64-multidetector computed tomography (CT) for blunt small bowel perforation (BSBP). The study included 106 CT examinations of surgically proven blunt bowel and mesentery injuries (78 of BSBP and 28 of non-BSBP). CT diagnosis was based on detection of bowel wall discontinuity or extraluminal gas. Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of CT diagnosis were 84.0%, 79.5%, 96.4%, 98.4%, and 62.8%, respectively. Bowel wall discontinuity and extraluminal gas were detected on 19.2% and 74.4% examination, respectively. CT diagnosis of BSBP is highly specific but not sensitive.
    Clinical imaging 07/2013; · 0.73 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Mortality from colorectal trauma decreased from the end of the 19th Century, when death was the rule, to the 21st Century, when mortality is 5%. The greatest advances were produced during wars, mainly due to improved transport conditions, antisepsis, advances in operating and anesthetic techniques, the management of fluids, blood and blood products, the use of antibiotics, exteriorization of wounds, and the use of colostomy. Injuries to the anus, rectum and colon are infrequent. Their prevalence is difficult to establish because they can be caused by several factors. In Spain, the most frequent causes are traffic accidents and iatrogenic lesions, while in America the most common causes are stab or gunshot wounds. Although the etiology of these injuries is diverse, two major groups of colorectal trauma can be established: accidental injuries and iatrogenic trauma. Clinical symptoms vary, ranging from abdominal, pelvic, perianal or anal pain, sometimes associated with rectorrhagia, to peritonismus or shock. Diagnosis is based on physical and rectal examination and laboratory, radiological, and endoscopic investigations. Laparoscopy can also be used on occasions. Treatment should be individualized, depending on the patient's history, current status, the time elapsed since injury, the status of the injured intestine, the degree of fecal contamination, associated lesions, and the surgeon's experience.
    Cirugia Espanola - CIR ESPAN. 01/2006; 79(3):143-148.
  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate mutidetector computed tomography (MDCT) for the prediction of perforation site according to each gastrointestinal (GI) tract site and elapsed time. One hundred and sixty-eight patients who underwent MDCT before laparotomy for GI tract perforation were enrolled and allocated to an early or late lapse group based on an elapsed time of 7 h. Two reviewers independently evaluated the perforation site and assessed the following CT findings: free air location, mottled extraluminal air bubbles, focal bowel wall discontinuity, segmental bowel wall thickening, perivisceral fat stranding and localised fluid collection. The overall diagnostic accuracy was 91.07 % and 91.67 % for reviewers 1 and 2, respectively, with excellent agreement (kappa 0.86). Accuracies (98.97 % and 97.94 %) and agreements (kappa 0.894) for stomach and duodenum perforation were higher than for other perforation sites. Strong predictors of perforation at each site were: focal bowel wall discontinuity for stomach, duodenal bulb and left colon, mottled extraluminal air bubbles for retroperitoneal duodenum and right colon, and segmental bowel wall thickening for small bowel. The diagnostic accuracy was not different between the early- and late-lapse groups. MDCT can accurately predict upper GI tract perforation with high reliability. Elapsed time did not affect the accuracy of perforation site prediction. • Perforation of the stomach and duodenum can be accurately predicted with MDCT. • Knowledge of CT findings predicting perforation site can improve diagnostic accuracy. • Elapsed time does not significantly affect accuracy in predicting perforation sites.
    European Radiology 03/2014; · 4.34 Impact Factor