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Bowel trauma (case studies)

We can now reinforce the concepts of CT evaluation for bowel injury lesson by reviewing a series of real CT cases.

Case 1: Motor vehicle collision

A 22 year old female restrained driver is transferred to emergency by ambulance following a high-speed motor vehicle collision. An abdominal CT scan is performed.

Review of SOLID ORGANS

Review of BOWEL

TREATMENT


Case 2: Knife wound

A 20 year old male is rushed to the ER following a knife wound to the left lateral flank. An abdominal CT scan is performed.

Immediate review

Review of SOFT TISSUES

Review of BOWEL

TREATMENT


Case 3: Skydiving injury

This case features a patient who presented after a skydiving injury with abdominal pain.

General review

Starting our review in the upper abdomen, we notice a lot of dark space in front of the liver. This is free intraperitoneal air. There is also some fluid and dots of air in the left abdomen, likely due to bowel perforation.

Abdominal CT Trauma case deceleration injury 1a

Flipping to lung windows, we can see this free intraperitoneal air more clearly, and how the air outlines the falciform ligament, connecting the liver to the anterior body wall.

Abdominal CT Trauma case deceleration injury 2a

Remember, free air indicates that there has been perforation of the bowel, so let’s take a closer look on soft tissue windows to see if we can locate the site of injury. There are smaller pockets or dots of air surrounding mildly thickened small bowel loops in the left upper quadrant, particularly surrounding the jejenum.

Abdominal CT Trauma case deceleration injury 3

The proximal jejunum is tethered to the retroperitoneum at the ligament of Treitz. A deceleration injury can tear the jejunum near this fixation point—a likely mechanism of injury in this skydiving accident.

Abdominal CT Trauma case deceleration injury 4

Treatment

This patient was taken to the operating room where jejunal injury was confirmed and repaired. The fluid and small pockets of air helped direct the surgical team’s attention directly to the location of the injury.


This is an edited excerpt from the Medmastery course Abdomen CT: Trauma by Michael P. Hartung, MD. Acknowledgement and attribution to Medmastery for providing course transcripts

References

Radiology Library: Abdominal Trauma. Solid organ injury

Abdominal CT interpretation

Assistant Professor of Abdominal Imaging and Intervention at the University of Wisconsin Madison School of Medicine and Public Health. Interests include resident and medical student education, incorporating the latest technology for teaching radiology. I am also active as a volunteer teleradiologist for hospitals in Peru and Kenya. | Medmastery | Radiopaedia | Website | Twitter | LinkedIn | Scopus 

Dr Adam Brown LITFL Author

MBChB (hons), BMedSci - University of Edinburgh. Living the good life in emergency medicine down under. Interested in medical imaging and physiology. Love hiking, cycling and the great outdoors.

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