Traumatic hollow viscus and mesenteric injury: role of CT and potential diagnostic–therapeutic algorithm

Despite its rarity, traumatic hollow viscus and mesenteric injury (HVMI) have high mortality and complication rates. There is no consensus regarding its best management. Our aim is to evaluate contrast enhanced CT (ceCT) in the screening of HVMI and its capability to assess the need for surgery. All trauma patients admitted to an urban Level 1 trauma center between 2010 and 2018 were retrospectively evaluated. Patients with ceCT scan prior to laparotomy were included. Patients requiring surgical repair of HVMI and a ceCT scan consistent with HVMI were considered true positives. Six ceCT scan criteria for HVMI were used; at least one criterion was considered positive for HVMI. Sensitivity (Sn), specificity (Sp), predictive values (PV), likelihood ratios (LR) and accuracy (Ac) of ceCT of single ceCT criteria and of the association of ceCT criteria were calculated using intraoperative findings as gold standard. Therapeutic time (TT), death probability (DP), and observed mortality (OM) were described. 114 of 4369 patients were selected for ceCT accuracy analysis; 47 were considered true positives. Sn of ceCT for HVMI was 97.9%, Sp 63.6%, PPV 66.2%, NPV 97.6%, + LR 2.69, −LR 0.03, Ac 78%; no single criterion stood out. The association of four or more criteria improved ceCT Sp to 98.5%, PPV to 95.6%, + LR to 30.5. Median TT was 2 h (IQR: 1–3 h). OM was 7.8%—not significantly higher than overall OM. CeCT in trauma has become a reliable screening test for HVMI and a valid exam to select HVMI patients for surgical exploration.

Ruptures of mesentery- a silent posttraumatic injury (Case Report)

The mechanism of mesenteric injury in blunt abdominal trauma involves compression and deceleration forces which result in a spectrum of injuries that range from contusions to tearing of the bowel wall, tearing of the mesentery, and loss of vascular supply. Hemoperitoneum is a major sign of severity in abdominal trauma, which, in most cases, requires emergency surgery.Our patient showed that the diagnosis of mesenteric injury should be considered even in patients who sustain only minor abdominal trauma. In this case the patient’s symptoms were suggestive only for the orthopedic lesion and not for the hemoperitoneum.Trans-scapho-lunate dislocation fracture is a rare lesion that may go unnoticed at initial assessment in a polytraumatized patient. A delay in the diagnosis and treatment of a scaphoid fracture may alter the prognosis after consolidation.

Renal artery embolisation immediately prior to emergency trauma nephrectomy

The aim of emergency nephrectomy in cases of blunt renal trauma is to control bleeding and so should not be delayed. We present a case of grade V blunt renal trauma where renal artery emoblisation (RAE) was used in the operating theatre immediately prior to trauma nephrectomy in order to control arterial haemorrhage. In this case, prior utilisation of RAE allowed the urologist to perform a standard approach to the renal pedicle by opening the retroperitoneal space. This is more routinely practiced and carries less risk of vascular mesenteric injury compared with the standard approach in trauma. Intra-operatively, there was minimal bleeding and the intra-vascular coils were easily ligated. Post operatively the patient avoids the sequelae of an ischaemic kidney associated with delayed interval nephrectomy.

Evaluation of Bowel and Mesentery in Abdominal Trauma

Since the advent of multidetecter computed tomography (CT), radiologist sensitivity in detection of traumatic bowel and mesenteric abnormalities has significantly improved. Although several CT signs have been described to identify intestinal injury, accurate interpretation of these findings can remain challenging. Early detection of bowel and mesenteric injury is important as it alters patient management, disposition, and follow-up. This article reviews the common imaging findings of traumatic small bowel and mesenteric injury.