Traumatic bowel perforation: analysis of CT findings according to the perforation site and the elapsed time since accident.
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).
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ABSTRACT: BACKGROUND: Isolated small bowel injury (ISBI) related to abdominal blunt trauma is rare. Timely diagnosis could be difficult, especially in the absence of modern imaging and laparoscopic facilities. The determinants of mortality under such circumstances are unclear. METHODS: This study presents twenty three cases of ISBI related to blunt abdominal injury identified between January 2005 and December 2009 in a level III Hospital in Limbe, Cameroon. Data were retrieved from an ongoing prospective study on injuries and augmented by analysis of individual patient's files. We analysed information regarding modalities of diagnosis, delay between injury and diagnosis, operative findings, treatment and outcome. RESULTS: The ages of our patients ranged from 7 to 38 years with a mean of 19 years. Thirteen patients were children below the age of 16. The most frequent mechanism of injury was a fall (n=11). Associated lesions were identified in 7 patients. Delay between injury and diagnosis was above 12h in 16 patients. Fifteen cases were admitted with obvious signs of peritonitis. Erect chest X-ray identified a pneumoperitoneum in 11 of the 17 patients for whom it was requested. Most perforations were located in the ileum. A total of 7 complications occurred in 5 patients. These included 4 cases of post-operative peritonitis. Two patients with at least one associated lesion died. CONCLUSION: ISBI is seldom suspected. This causes delay in diagnosis and most cases present with a diffuse peritonitis. Early diagnosis and management in low income environment is likely to be improved by a greater awareness of clinicians about this injury, serial clinical assessment and repeated erect chest X-ray, rather than sophisticated tools such as CT scan or laparoscopy.Injury 04/2013; · 1.93 Impact Factor
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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
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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