Maria Cristina Firetto1, Francesco Sala2, Marcello Petrini3, Alessandro A Lemos4, Tiberio Canini5, Stefano Magnone6, Gianluca Fornoni7, Ivan Cortinovis8, Sandro Sironi2, Pietro R Biondetti1. 1. Department of Radiology, Ca' Granda IRCSS Maggiore Policlinico Hospital Foundation Trust, Via Francesco Sforza 35, 20122, Milan, Italy. 2. Department of Radiology, Pope John XXIII Hospital, University of Milan Bicocca, Piazza O.M.S 1, 24127, Bergamo, Italy. 3. Postgraduation School in Diagnostic Radiology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy. 4. Department of Radiology, Ca' Granda IRCSS Maggiore Policlinico Hospital Foundation Trust, Via Francesco Sforza 35, 20122, Milan, Italy. alemos@sirm.org. 5. Department of General and Emergency Surgery, Ca' Granda IRCSS Maggiore Policlinico Hospital Foundation Trust, Via Francesco Sforza 35, 20122, Milan, Italy. 6. Department of General Surgery, Pope John XXIII Hospital, Piazza O.M.S 1, 24127, Bergamo, Italy. 7. Postgraduation School in General Surgery, Universiy of Milan, Via Festa del Perdono 7, 20122, Milan, Italy. 8. Department of Clinical Sciences and Community Health, Laboratory G.A. Maccacaro, University of Milan, 20122, Milan, Italy.
Abstract
BACKGROUND: Bowel and/or mesentery injuries represent the third most common injury among patients with blunt abdominal trauma. Delayed diagnosis increases morbidity and mortality. The aim of our study was to evaluate the role of clinical signs along with CT findings as predictors of early surgical repair. MATERIAL AND METHODS: Between March 2014 and February 2017, charts and CT scans of consecutive patients treated for blunt abdominal trauma in two different trauma centers were reread by two experienced radiologists. We included all adult patients who underwent contrast-enhanced CT of the abdomen and pelvis with CT findings of blunt bowel and/or mesenteric injury (BBMI). We divided CT findings into two groups: the first included three highly specific CT signs and the second included six less specific CT signs indicated as "minor CT findings." The presence of abdominal guarding and/or abdominal pain was considered as "clinical signs." Reference standards included surgically proven BBMI and clinical follow-up. Association was evaluated by the chi-square test. A logistic regression model was used to estimate odds ratio (OR) and confidence intervals (CI). RESULTS: Thirty-four (4.1%) out of 831 patients who sustained blunt abdominal trauma had BBMI at CT. Twenty-one out of thirty-four patients (61.8%) underwent surgical repair; the remaining 13 were treated conservatively. Free fluid had a significant statistical association with surgery (p = 0.0044). The presence of three or more minor CT findings was statistically associated with surgery (OR = 8.1; 95% CI, 1.2-53.7). Abdominal guarding along with bowel wall discontinuity and extraluminal air had the highest positive predictive value (100 and 83.3%, respectively). CONCLUSION: In patients without solid organ injury (SOI), the presence of free fluid along with abdominal guarding and three or more "minor CT findings" is a significant predictor of early surgical repair. The association of bowel wall discontinuity with extraluminal air warrants exploratory laparotomy.
BACKGROUND:Bowel and/or mesentery injuries represent the third most common injury among patients with blunt abdominal trauma. Delayed diagnosis increases morbidity and mortality. The aim of our study was to evaluate the role of clinical signs along with CT findings as predictors of early surgical repair. MATERIAL AND METHODS: Between March 2014 and February 2017, charts and CT scans of consecutive patients treated for blunt abdominal trauma in two different trauma centers were reread by two experienced radiologists. We included all adult patients who underwent contrast-enhanced CT of the abdomen and pelvis with CT findings of blunt bowel and/or mesenteric injury (BBMI). We divided CT findings into two groups: the first included three highly specific CT signs and the second included six less specific CT signs indicated as "minor CT findings." The presence of abdominal guarding and/or abdominal pain was considered as "clinical signs." Reference standards included surgically proven BBMI and clinical follow-up. Association was evaluated by the chi-square test. A logistic regression model was used to estimate odds ratio (OR) and confidence intervals (CI). RESULTS: Thirty-four (4.1%) out of 831 patients who sustained blunt abdominal trauma had BBMI at CT. Twenty-one out of thirty-four patients (61.8%) underwent surgical repair; the remaining 13 were treated conservatively. Free fluid had a significant statistical association with surgery (p = 0.0044). The presence of three or more minor CT findings was statistically associated with surgery (OR = 8.1; 95% CI, 1.2-53.7). Abdominal guarding along with bowel wall discontinuity and extraluminal air had the highest positive predictive value (100 and 83.3%, respectively). CONCLUSION: In patients without solid organ injury (SOI), the presence of free fluid along with abdominal guarding and three or more "minor CT findings" is a significant predictor of early surgical repair. The association of bowel wall discontinuity with extraluminal air warrants exploratory laparotomy.
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