Abstract
Traumatic bowel mesenteric injury (TBMI) is a challenge in trauma care. The presence of free peritoneal fluid (FF) in computed tomography (CT) was considered the indication for surgical intervention. However, conservative treatment should be applied for minor injuries. We conduct a systematic review to analyze how reliable the FF is to assess the TBMI. Publications were retrieved by structured searching among databases, review articles and major textbooks. For statistical analysis, summary receiver operating characteristic curves (SROCs) were computed using hierarchical models. Fourteen studies enrolling 4336 patients were eligible for final qualitative analysis. The SROC line was created by a hierarchical summary receiver operating characteristic model. The summary sensitivity of FF to predict surgical TBMI was 0.793 (95% CI: 0.635–0.894), and the summary specificity of FF to predict surgical TBMI was 0.733 (95% CI: 0.468–0.896). The diagnostic odds ratio was 10.531 (95% CI: 5.556–19.961). This study represents the most robust evidence (level 3a) to date that FF is not the absolute but an acceptable indicator for surgically important TBMI. However, there is still a need for randomized controlled trials to confirm.
Highlights
Traumatic mesenteric injury (TBMI) is a challenging setting in trauma care
We reviewed the literature in English to provide a thorough evaluation of the current state of the art of free peritoneal fluid (FF) in computed tomography (CT) in diagnosing surgically important Traumatic bowel mesenteric injury (TBMI)
Traumatic mesenteric injuries are defined as an injury of the mesentery, mesocolon, and supplying vessels of hollow abdominal viscus, where the organ is directly injured from trauma and needs resection, repair, or control of bleeding for definitive treatment, or where hollow viscus injury due to direct trauma is detected by CT and managed conservatively
Summary
Traumatic mesenteric injury (TBMI) is a challenging setting in trauma care. After blunt trauma, bowel and mesenteric injuries are infrequent, reported among 5% of abdominal trauma, but they are dangerous. TBMI causes significant blood loss from disrupted mesenteric vessels immediately and remotely from injury time. The disruption of blood flow will lead to bowel ischemia, necrosis, and the discontinuity of the wall with eventual delayed rupture or ischemic strictures [1,2,3]. Unrecognized bowel and mesenteric injuries may account for high morbidity and mortality [4,5,6,7]. Surgical intervention, at least with laparoscopic exploration, became the leading strand when the TBMI was suspicious. Non-therapeutic surgical intervention has been associated with increased patient morbidity and increased hospital stay [4,8,9,10,11,12]
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