CT FINDINGS OF MESENTERIC INJURY AFTER BLUNT TRAUMA - IMPLICATIONS FOR SURGICAL INTERVENTION

OBJECTIVE. The purposes of this study were to determine the spectrum o f CT findings of mesenteric injury, to compare CT findings of mesenter ic injury with surgical observations, and to assess the potential of C T to predict which patients with mesenteric injury require laparotomy. MATERIALS AND METHODS. Blunt trauma patients admitted to our facility during a 5-year 4-month period with a CT or surgical diagnosis of mes enteric injury were identified from a radiology database and trauma re gistry. Patients with CT findings of full-thickness bowel injury assoc iated with mesenteric injury or diagnostic peritoneal lavage performed before CT were excluded. CT scans of all patients were retrospectivel y reviewed both with and without knowledge of surgical results. Medica l records of all study patients were reviewed to ascertain admission p hysical findings and surgical results. RESULTS. Twenty-seven of 29 pat ients meeting the study criteria underwent laparotomy, and two others were managed conservatively. Among the 27 patients who had surgery, 24 (89%) had CT findings of mesenteric injury confirmed. Surgical findin gs showed CT scans to be falsely negative in two other patients and fa lsely positive in one other patient. No major discrepancies were found between retrospective CT review done with and without knowledge of th e surgical findings. Two CT findings unique to patients whose injuries , in the judgment of the surgical team. required surgical repair were active extravasation of IV contrast material and bowel wall thickening associated with mesenteric findings. Physical findings did not correl ate well with the type and clinical significance of the mesenteric inj ury. CONCLUSION. The CT finding of mesenteric bleeding or bowel wall t hickening associated with mesenteric hematoma or infiltration in the b lunt trauma patient indicates a high likelihood of a mesenteric or bow el injury requiring surgery. The finding of focal mesenteric hematoma or infiltration without adjacent bowel wall thickening is nonspecific and can occur both in mesenteric or bowel lesions that require surgery and those that do not.