Bowel and mesenteric injury in blunt trauma: Diagnostic efficiency and importance of experience in using multidetector computed tomography

Abstract

BACKGROUND: The purpose of this study was to investigate the diagnostic efficiency of multidetector computed tomography (MDCT) in the detection of blunt bowel and mesenteric injuries (BBMI), and the role of different experience levels in using MDCT. METHODS: This study included a test group of twenty-seven patients with surgically important BBMI in whom the diagnoses were confirmed after surgical intervention (23 men and 4 women; mean age, 40.7 +/- 16.2; range, 18-76), and a control group of twenty-one matched patients without BBMI who underwent laparotomy for trauma during the same time period (16 men and 5 women; mean age, 38.9 +/- 14.5; range, 20-68) and sixteen-detector computed tomography prior to surgery. Intraoperative findings were compared with MDCT findings. RESULTS: High accuracy, specificity, and positive predictive values in MDCT findings with respect to intraperitoneal free air, mesenteric air, thickened (>4-5 mm) and defected bowel wall, increased contrast enhancement on bowel wall, and mesenteric hematoma were found among others (p<0.01). Sensitivities and specificities of the diagnosis of BBMI by the resident and staff radiologist was 74% and 71%, and 85% and 100%, respectively. CONCLUSION: MDCT displays BBMI with high sensitivity and specificity, and can predict the need for surgery. Experience in radiology is an important factor for appropriate interpretation of the MDCT findings.