Bret Allan Landry MD, Presenter: Nothing to Disclose

Samir Faidi MD, FRCPC, Abstract Co-Author: Nothing to Disclose

Angela Coates MEd, Abstract Co-Author: Nothing to Disclose

Michael Nathan Patlas MD, FRCPC, Abstract Co-Author: Nothing to Disclose

Traumatic bowel and mesenteric injury (TBMI) is an uncommon entity that can be lethal if not detected and treated in a timely manner. The purpose of our study was to evaluate the diagnostic accuracy of 64MDCT for the detection of TBMI in patients at our level 1 trauma centre.  

We used our hospital's trauma registry to identify patients with a diagnosis of TBMI from January 1, 2006 to June 30, 2013. Only patients who had a 64MDCT scan at presentation and subsequently underwent laparotomy/laparoscopy were included in the study cohort. Using the surgical findings as the gold standard, the accuracy of prospective radiology reports was analyzed.

Of the 4781 trauma patients who presented to our institution, 44(0.9%) had surgically proven TBMI. 22/44 were excluded as they did not have MDCT before surgery. The study cohort consisted of 14 males and 8 females with a median age of 41.5 years and a median Injury Severity Score of 27. 17/22 had blunt trauma and 5/22 had penetrating injury. A correct preoperative imaging diagnosis of TBMI was made in 14/22 of patients. The overall sensitivity of the radiology reports was 63.6% (95% CI: 41-82%), specificity was 79.6 % (95% CI: 67-89%), PPV was 53.9% (95% CI: 33 -73 %) and NPV was 85.5% ( 95% CI: 73-94 %). The accuracy was 90.5%. However, only 59 % (10/17) of patients with blunt injury had a correct preoperative diagnosis. Review of the findings demonstrated that majority of patients with missed blunt TBMI (5/7) demonstrated only indirect signs of injury.

The detection of TBMI in trauma patients on 64MDCT can be improved, especially in patients presenting with blunt injury. Missed cases in this population occurred because the possibility of TBMI was not considered despite the presence of indirect imaging signs.

The prospective diagnosis of TBMI remains challenging despite advances in CT technology and widespread use of 64MDCT.

Landry, B, Faidi, S, Coates, A, Patlas, M, Are We Missing Traumatic Bowel and Mesenteric Injuries?  .  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14000272.html