Blunt bowel and mesenteric injuries: The role of screening computed tomography

Background: Early generation scanners have demonstrated poor sensitivity de tecting blunt bowel/mesenteric injuries (BBMI). This study was aimed at det ermining the accuracy and role of helical scanners in BBMI. Methods: Retrospective chart review of patients with BBMI, or computed tomo graphic scans suspicious of BBMI, from August of 1995 to December of 1998. Results: One hundred of 8,112 scans (1.2%) were suspicious of BBMI, Of thes e suspicious scans, 53 patients had BBMI (true positive-TP) and 47 patients did not (false positive-FP). Seven patients with negative scans had BBMI ( false negative-FN). Computed tomography contributed toward early surgery in 77% of patients who may have been delayed. Six patients developed intra-ab dominal abscess. The abscess group had a significantly longer time interval from injury to surgery. Multiple findings were seen in 57% of true positiv e scans, whereas in 13% of false positive scans (p < 0.0001), An algorithm for management of BBMI is presented. Conclusion: Helical scanners have high accuracy in detecting BBMI, Single v ersus multiple findings are useful in managing these injuries.