Jejunum and ileum blunt trauma: what has changed with the implementation of multislice computed tomography?

Raquel Oliveira Menna Barreto De Araújo,Sandro Rizoli,Gustavo Pereira Fraga,Mario Eduardo De Faria Mantovani,Thiago José Penachim,Bruno Monteiro Tavares Pereira,Marina Pimentel De Matos

doi:10.1590/0100-699120140040010

Abstract

to evaluate the impact of the new technology of multidetector computed tomography (MDCT) in improving the accuracy and early diagnosis of BSBI. patients with blunt small bowel injuries (BSBI) grade> I were identified retrospectively and their CT scans reviewed by an experienced radiologist. Clinical and tomographic findings were analyzed and patients grouped as "pre-MDCT" and "post-MDCT", according to the time of implementation of a 64-slice MDCT. of the 26 patients with BSBI 16 had CT scans. Motor vehicle collision (62.5%) was the most frequent mechanism of injury. In the pre-MDCT period, five of the 13 patients (38.5%) had abdominal CT, and in the post-MDCT, 11 of 13 patients (84.6%) had the exam. During pre-MDCT, all CT scans were abnormal with findings of pneumoperitoneum (60%), free fluid (40%) and bowel wall enhancement (20%). In the post-MDCT group, all exams but one were abnormal and the most frequent findings were free fluid (90.9%), bowel wall enhancement (72.7%), and pneumoperitoneum (54.5%). However, the rate of delayed laparotomy did not change. The mortality rate in both groups were similar, with 20% during pre-MDCT and 18.2% during post-MDCT. the use of MDCT in abdominal trauma in our service has increased the sensibility of the diagnosis, but has had no impact on outcome so far.

Highlights

The small bowel can be injured by both penetrating trauma with disruption of the abdominal wall and blunt trauma
The study subjects were patients who had small bowel injuries(SBI) caused by blunt trauma, who were admitted to the Referral Emergency Unit (UER), Clinical Hospital (HC) of University of Campinas (Unicamp) and who underwent surgery between 2005 and 2012, excluding patients younger than 14 years of age
CT was performed on 5 of the 13 cases admitted before CT multislice (38.5%) and on 11 of the 13 cases assessed by the auxiliary equipment (84.6%), these 16 patients were included in the study

Summary

Introduction

The small bowel can be injured by both penetrating trauma with disruption of the abdominal wall and blunt trauma. It is the most frequently injured viscera in penetrating abdominal trauma and currently the third most common injury following blunt trauma[1,2,3]. Direct bowel injury or to the mesentery occurs in approximately 1% to 5% of all blunt abdominal traumas, and its incidence is increasing with the growing number of automobile crashes[4]. Blunt small bowel injuries (BSBI) may be caused by sports injuries, work-related incidents and falls[5]. Small bowel disruption caused by explosions may occur,when the intraluminal pressure exceeds the intestinal wall tension[5]

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