Emergency Body CT > Trauma > Bowel


Bowel

Injury to the bowel is infrequent, occurring in less than 5 percent of blunt abdominal injuries. Such injuries are most often associated with motor vehicle accidents and the prevalence of bowel injuries has increased with the increased use of lap-type seat belt restraints. Injuries can occur as a result of direct compression between the vertebral column and the abdominal wall or a shearing type injury near mesenteric fixation points like the ligament of Trietz and the iliocecal junction. The extent of injury can range from focal mural hematomas to complete transection. Injury more commonly involves the duodenum, primarily the second and third segments. Colonic injury is less common than duodenal or small bowel involvement.


Perforation with extravasation of contrast from the

duodenum (arrow).

Prompt clinical diagnosis of bowel injury is difficult. The classic triad of tenderness, rigidity, and absent bowel sounds only occurs in about 30% of patients. In addition the signs and symptoms of bowel injury can be delayed and physical examination is not specific or sensitive. The consequence of a missed diagnosis can be catastrophic. Undetected bowel perforation can lead to fatal peritonitis and a delay of 24 hours without surgical intervention has been shown to increase mortality from 5% to 65%. For these reasons, CT is crucial for the early detection of bowel trauma.



Mesenteric laceration with hemoperitoneum(arrows).



Ischemic bowel episode due to trauma ("shock bowel").

 

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