Rupture of the bowel after blunt abdominal trauma: diagnosis with CT.

OBJECTIVE. The accuracy of CT in the detection of injuries of the solid viscera after blunt trauma is well established, but the value of CT in diagnosing bowel rupture resulting from blunt trauma is controversial. This study was conducted to determine the sensitivity of CT in diagnosing posttraumatic bowel rupture. SUBJECTS AND METHODS. During a 51-month period, 17 preoperative CT scans were obtained in 16 patients who subsequently had bowel ruptures verified surgically. Both preoperative (prospective) and retrospective CT findings were analyzed in these patients. Retrospective interpretation was made by consensus of two radiologists. RESULTS. Surgically confirmed bowel ruptures occurred in the duodenum (five), ileum (four), jejunum (four), colon (four), and stomach (two). CT findings considered diagnostic of bowel perforation were detected prospectively on 10 (59%) of 17 scans; these included pneumoperitoneum without prior peritoneal lavage (six), mesenteric, intramural, or retroperitoneal free air (six), or direct visualization of discontinuity of the bowel wall or extravasation of luminal contents (four). Prospective CT findings considered suggestive of bowel rupture were present on five (29%) of the 17 scans; these included intraperitoneal fluid of unknown source (three), thickened (> 4-5 mm) bowel wall (two), gross anterior pararenal fluid without a recognized source (one), and a mesenteric-bowel wall hematoma (one). On two of 17 scans, findings were seen in retrospect only; these included free intraperitoneal blood without a source (findings on a second CT scan were diagnostic) and pneumoperitoneum. CT findings diagnostic or suggestive of bowel injury were detected prospectively on 15 (88%) of 17 scans and were noted in all retrospectively. CONCLUSION. CT is sensitive for the diagnosis of bowel rupture resulting from blunt trauma, but careful inspection and technique are required to detect often subtle findings.     

闭合性腹膜内型膀胱破裂的CT诊断

目的　确定闭合性腹膜内型膀胱破裂的CT诊断价值。方法　对 9例闭合性腹膜内型膀胱破裂的CT资料和临床处理进行回顾性分析。结果　所有 9例腹膜内型膀胱破裂 ,CT均明确诊断。CT显示腹膜腔内低密度液体积聚 9例 ,其CT值比血液低 ,主要分布在膀胱侧隐窝、盆腔陷凹、结肠旁沟、肝脾周围和肠袢内。膀胱壁局部缺损 3例 ,泪滴状变形 2例 ;其他支持膀胱破裂的CT征象包括 :膀胱充盈不良 8例 ,膀胱壁挫伤 4例 ,膀胱内血凝块 6例。结论　在创伤情况下 ,腹膜腔内出现CT值比血液小的低密度液体积聚 ,强烈提示尿外渗 ,根据尿外渗的分布范围 ,CT还可以区别腹膜内和腹膜外型膀胱破裂。CT有时还可以观察到膀胱破裂的准确位置 ,有利于手术修补     

增强CT对腹部实质脏器损伤的诊断价值

目的：探讨增强CT扫描检查对腹部实质脏器损伤的诊断价值。方法：回顾性分析63例经手术、血管造影及CT随访证为腹部钝性损伤病人的平扫及增强CT表现征象,并比较分析各种征象的作用。结果：本组63例中,11例（2例脾损伤,3例肝损伤,6例肾损伤）平扫换明显异常,增强CT扫描呈明显的低工改变;11例器官内或周围斑点状造影剂外渗,提示为活动性出血;29例增强 CT扫描后清楚显示裂伤部位,结论：增强CT检查对肝肾损伤的诊断明显优于平扫,还可以判断有无活动性出血等情况,对损伤程度的判断和治疗方案的制定较平扫更有价值。     

CT diagnosis of renal artery injury caused by blunt abdominal trauma

Controversy exists about the sensitivity of CT in the diagnosis of occlusion of the renal artery or one of its branches after blunt abdominal trauma. We report 10 cases in which contrast-enhanced CT was used to diagnose correctly either main (seven cases) or segmental (three cases) posttraumatic renal artery occlusion. The abnormality was proved angiographically and/or surgically in all cases. CT showed the absence of a nephrogram in the devascularized portion of the kidney in all 10 cases. A pyelogram was not shown on CT in the seven patients in whom the main renal artery was occluded, but was present in the three patients who had segmental arterial lesions. Termination of enhancement within the affected artery (renal artery cutoff sign) was observed in one patient, and a thin, peripheral rim of cortical enhancement in an otherwise unenhanced renal segment (rim sign) was observed in three patients. Retroperitoneal hematoma with renal displacement was present in nine patients. Our experience suggests that the absence of a nephrogram on contrast-enhanced CT scans is a useful sign of main or segmental renal arterial occlusion in patients with blunt abdominal trauma.     

多层螺旋CT诊断急性腹部闭合性外伤的临床价值

收集我院2009年9月～2011年8月经多层螺旋CT检查及手术证实急性腹部闭合性外伤58例患者临床资料,探讨多层螺旋CT诊断急性腹部闭合性外伤的临床价值。1材料与方法本组58例患者,其中男性47例,女性11例,年龄7～79岁,平均43岁。患者均有明确外伤史,其中车祸伤42例、     

闭合性喉损伤的CT诊断

目的 搪塞闭合性喉损伤的ＣＴ表现及诊断价值。方法 对１６例闭合性喉损伤病人的ＣＴ和临床资料进行回顾性分析。结果 软组织损伤５例,杓会厌襞和真假声带肿胀、气道狭窄４例,左环杓关节脱位,声带麻痹１例;声门损伤２例;均有会咽软骨骨折伴榴府厌襞和下咽部撕裂;声门损伤４例;甲状软骨右翼部骨折１例,甲状软骨前联合部纵行或粉碎骨折３例,其中１例骨折片进入喉腔形成异物,两侧声带和前联合撕脱;声门下损伤（５例）：左     

闭合性阴囊损伤的CT诊断

目的确定闭合性阴囊损伤的ＣＴ诊断价值。方法 对２３例闭合性阴囊损伤的ＣＴ资料及临床处理进行回顾性分析。结果 根据睾丸失去正常的卵圆形结构，白膜中断，睾丸组织突出或睾丸断片分离等征象，ＣＴ正确诊断睾丸破裂８例；ＣＴ亦能显示阴囊壁血肿，鞘膜积血，白膜下血肿，睾丸实质血肿，睾丸附睾挫伤，精索及附睾血肿等其他病理改变。１７例手术探查证实ＣＴ显示的各种病理改变与手术病理完全相符。结论 ＣＴ能准确诊断各种类型     

胰腺钝性伤的CT诊断

目的：总结分析胰腺钝性伤的CT征象。方法：经手术证实的胰腺钝性伤5例,回顾分析其CT表现及特点。结果：2例分别为胰腺断裂和实质出血的胰腺钝性伤患者,未能及时诊断和有效治疗,并发了重症胰腺炎、胰周感染和脓肿等严重并发症,致使住院治疗时间明显延长。另3例及时诊断和治疗,患者很快恢复出院,结论：CT是诊断胰腺钝性伤的首选方法。正确认识CT征象能及时作出诊断,为适时手术提供依据,从而减少并发症及死亡率,特别是对胰腺损伤程度严重的患者。     

钝性脾损伤的CT诊断

目的探讨CT非增强扫描对钝性脾损伤的诊断价值。方法回顾性分析经CT非增强扫描并经手术及临床确诊的41例钝性脾损伤。结果脾脏包膜下血肿12例,脾内血肿16例,脾撕裂伤19例,脾粉碎8例,伴有腹腔积血30例。无假阳性,3例假阴性,CT非增强扫描诊断脾损伤敏感性92.7%,特异性100%,准确率92.7%。结论CT非增强扫描能够较好的显示钝性脾脏损伤的表现,为临床治疗提供可靠依据。     

CT diagnosis of abdominal trauma

Computed tomography (CT) findings from 95 patients with blunt abdominal trauma were evaluated. Among them, there was no false negative case. It can thus be said that if CT is negative the patient can be treated conservatively. The efficacy of CT in diagnosing injuries of various organs was also evaluated.     

腹部闭合性创伤的急诊CT评价

目的：探讨急诊CT扫描在腹部闭合性创伤中的应用价值。方法：收集整理经手术或临床证实的腹部闭合性创伤65例急诊CT检查的影像资料,进行回顾性分析,所有病例均行CT平扫。结果：腹部闭合性创伤的急诊CT扫描主要表现为混杂高密度影像,多伴腹腔出血。本组65例腹部闭合性创伤中,肝脏损伤15例、脾26例、肾13例,肠系膜与肠管损伤2例,膀胱破裂2例,复合性实质性脏器损伤7例。其中51例伴腹腔出血,22例合并肋骨骨折。结论：急症CT扫描对诊断腹部闭合性创伤具有很大的价值,能明确腹部脏器损伤的部位、程度及复合性脏器损伤等信息,以指导临床医师制定有效的治疗方案。     

Evaluation of non-contrast-enhanced CT in blunt abdominal trauma]

We compared the findings of noncontrast-enhanced CT with those of contrast-enhanced CT in 126 patients with blunt abdominal trauma to evaluate the usefulness of noncontrast-enhanced CT. In 112 of the patients, visceral injuries were confirmed by surgery or clinical follow-up including CT. Although noncontrast-enhanced CT diagnosed all patients with 12 intestinal injuries requiring immediate surgery, contrast-enhanced CT missed two of these patients because high density hematomas on noncontrast-enhanced CT became isodense after IV administration of contrast material. However, contrast-enhanced CT was superior to noncontrast-enhanced CT in the diagnosis of hepatic and renal injuries. A case of renal artery occlusion was only visualized on contrast-enhanced CT. We conclude that both noncontrast- and contrast-enhanced CT should be performed for the CT evaluation of blunt abdominal trauma.     

CT of false-negative peritoneal lavage following blunt abdominal trauma

The CT findings are presented in a patient with blunt trauma and a false-negative peritoneal lavage due to extraperitoneal insertion of the lavage catheter. Computed tomography correctly identified the presence of hemoperitoneum and the site of injury involving the small bowel mesentery. The diagnostic accuracy in peritoneal lavage and its relationship to abdominal CT is reviewed.     

The clinical impact of CT for blunt abdominal trauma

The use of computed tomography (CT) has had a tremendous impact on the evaluation and management of blunt abdominal trauma. It is noninvasive, easy to perform, and has been shown to be highly sensitive (100%), specific (96.8%), and accurate (97.6%). The use of CT has helped decrease the total number of laparotomies performed for abdominal trauma at this institution (231 in 1975-1976, 74 in 1983) as well as the number of negative and nontherapeutic laparotomies. The use of other diagnostic tests such as radionuclide scans and angiography in blunt abdominal trauma has been virtually replaced by CT. Of the 41 peritoneal lavages performed in 1983, 39 were in patients who were in the operating room for treatment of other extraabdominal injuries (i.e., closed head injury, severe extremity trauma).     

The value of non-contrast-enhanced CT in blunt abdominal trauma

The usefulness of non-contrast CT, limited to the upper abdomen, in conjunction with conventional IV contrast-enhanced scanning was studied prospectively in 190 patients who had sustained blunt abdominal trauma. In 78, visceral injuries were confirmed at surgery or at follow-up CT. Of the patients with injuries, 14 (18%) had hyperdense hematomas on the non-contrast studies that became isodense after IV administration of contrast material. These hematomas generally were small and posed an immediate threat to life in only one patient (0.5% of all subjects). In 13% of patients with injury (5% of the total), the additional information did influence treatment planning (surgery in two and intensive conservative treatment in eight). Compared with conventional contrast scanning, the combined non-contrast-contrast technique increased the scanning time only by about 5 1/2 min, but it improved the sensitivity and accuracy of CT in detecting visceral injuries from 74% and 84% to 92% and 91%, respectively (p less than or equal to .003 and p less than or equal to .04). Although contrast-enhanced scanning alone accurately depicts visceral injuries requiring surgical treatment, the incorporation of a non-contrast sequence can detect a subgroup of patients who require intensive conservative management with bed rest and close observation. This additional information can be obtained expeditiously, with minimal additional effort or intervention. The use of non-contrast scanning alone is not recommended.     

多层螺旋CT对腹部闭合性损伤的诊断价值

<正>腹部损伤约占所有损伤的0.4%～4.2%,常合并多脏器、多部位损伤而危及生命,其死亡率占所有损伤死亡率的10%。早期确诊腹部损伤的类别和准确定位有助于对伤者采取果断有效的处理措施、提高抢救成功率、降低死亡率、减少并发症。MSCT     

The value of CT in detecting bowel perforation in children after blunt abdominal trauma

In this era of conservative management for most infants and children with blunt abdominal trauma, there is a concern that the diagnosis of bowel perforation may be missed or delayed. To determine the sensitivity of CT in the detection of perforated viscus in this population, we reviewed the CT examinations of 547 consecutive children who had had blunt abdominal trauma. Of six patients (1%) with documented bowel perforation, four (67%) had free intraperitoneal air detected preoperatively by CT. The remaining two cases had secondary signs of bowel thickening and unexplained peritoneal fluid. Free intraperitoneal air was not a specific indicator for bowel perforation. Of nine patients in whom CT studies showed pneumoperitoneum, only four (44%) had a ruptured bowel. The remaining five patients had pneumoperitoneum from sources other than bowel perforation including pneumomediastinum, bladder perforation, and previous peritoneal lavage. This experience shows that the CT finding of pneumoperitoneum is useful, although not specific for the detection of bowel perforation in children with blunt abdominal trauma. When free air is not present, secondary signs of bowel wall thickening and unexplained peritoneal fluid suggest a bowel perforation.