Bowel and mesenteric injury evaluation with emergency abdominal US

PURPOSE: To assess emergency ultrasonography (US) for detection of bowel an d mesenteric injury from blunt trauma. MATERIALS AND METHODS: For 3 years, prospective data on all patients underg oing emergency US were recorded. Patients with bowel and mesenteric injury were identified, and physical examination, laboratory, computed tomographic (CT), and intraoperative findings were compared with prospective data. RESULTS: From January 1995 to January 1998, emergency US was performed in 1 ,686 patients; 71 patients had bowel and mesenteric injury. Forty-one exami nations were true-positive (ie, with free fluid), and 30 were false-negativ e. Twenty-five of the 41 patients with true-positive US results had concomi tant injuries that may have accounted for the free fluid, including liver, spleen, pancreas, gallbladder kidney, and/or bladder injuries. The remainin g 16 patients had isolated bowel and mesenteric injury. Bowel and mesenteri c damage was identified intraoperatively in 70 patients. Twenty-nine of 30 patients with false-negative US examinations had abdominal tenderness. Sixt een patients with false-negative US results had bowel and mesenteric injury that was detected 12 or more hours after initial scanning. CONCLUSION: Free fluid in the abdomen is not detected in the majority of pa tients with isolated bowel and mesenteric injury. For clinical suspicion of bowel and mesenteric injury, observation, serial physical abdominal examin ation, and CT may be helpful in diagnosing this condition.