Helical computed tomography of bowel and mesenteric injuries

Background: The role of computed tomography in diagnosing hollow viscus inj ury after blunt abdominal trauma remains controversial,,vith previous studi es reporting both high accuracy and poor results. This study was performed to determine the diagnostic accuracy of helical computed tomography in dete cting bowel and mesenteric injuries after blunt abdominal trauma in a large cohort of patients. Methods: One hundred fifty patients were admitted to our Level I trauma cen ter over a 4-year period with computed tomographic (CT) scan or surgical di agnosis of bowel or mesenteric injury. CT scan findings were retrospectivel y graded as negative, nonsurgical, or surgical bowel or mesenteric injury. The CT scan diagnosis was then compared with surgical findings, which were also graded as negative, nonsurgical, or surgical. Results: Computed tomography had an overall sensitivity of 94% in detecting bowel injury and 96% in detecting mesenteric injury. Surgical bowel cases were correctly differentiated in 64 of 74 cases (86%), and surgical mesente ric cases were correctly differentiated from nonsurgical in 57 of 76 cases (75%). Conclusion: Helical CT scanning is very accurate in detecting bowel and mes enteric injuries, as well as in determining the need for surgical explorati on in bowel injuries. However, it is less accurate in predicting the need f or surgical exploration in mesenteric injuries alone.