The role of computed tomography in the diagnosis and management of clinically occult post-traumatic small bowel perforation

Abstract Purpose To evaluate the use of computed tomography [CT] in the diagnosis of occult post-traumatic small bowel perforation and to discuss the role of CT in the management of this patient group. Method This review includes three patients who presented with mild abdominal symptoms following mi...

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Bibliographic Details
Published in:Radiography (London, England. 1995) England. 1995), 2009-08, Vol.15 (3), p.228-232
Main Authors: Ahmed, I, Ahmed, N, Bell, D.J, Hughes, D.V, Evans, G.H, Howlett, D.C
Format: Article
Language:English
Subjects:
Abdominal
Computed tomography
Duodenum
Injuries
Intestine
Mesentery
Perforation
Radiography
Radiology
Reviews
Small bowel
Trauma
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Summary:Abstract Purpose To evaluate the use of computed tomography [CT] in the diagnosis of occult post-traumatic small bowel perforation and to discuss the role of CT in the management of this patient group. Method This review includes three patients who presented with mild abdominal symptoms following minor blunt abdominal trauma. Initial radiographs and laboratory investigations were unremarkable but their symptoms failed to resolve and contrast-enhanced CT was performed for further evaluation. Results In each case the CT appearances were indicative of localised small bowel perforation, with no evidence of other visceral injury. In two patients pockets of free intraperitoneal air were present closely related to the second part of the duodenum suggesting injury at this site. In the third case, a thickened proximal jejunal loop was demonstrated with free air and fluid in the adjacent mesentery consistent with a focal perforation. These CT findings were subsequently confirmed at laparotomy. Conclusion CT is an accurate diagnostic tool in the assessment of clinically and radiologically occult traumatic small bowel injury. The use of CT should be considered in patients who have unresolving abdominal symptoms even after apparently insignificant abdominal trauma.
ISSN:1078-8174
1532-2831
DOI:10.1016/j.radi.2008.11.003