Early diagnosis of small intestine rupture from blunt abdominal trauma using computed tomography: significance of the streaky density within the mesentery.

Enhanced computed tomography (CT) was done in 430 patients within 3 hours after blunt abdominal trauma. Thirteen patients were found to have ruptures of the small intestine. Nine of them had "the streaky density within the mesentery" and the position was identified by tracing the alimentary tract on each CT slice. The sensitivity and specificity of this sign was 69 and 100% respectively. The sensitivity for diagnosis of small intestinal rupture by the presence of this sign and/or free air was 85%. This was significantly higher than that of free air alone (p < 0.05). Eight patients had a rupture on a mesenteric site. Histopathological findings of the area with this sign included bleeding and cellular infiltration along the mesenteric vasculature. This appearance may be related to direct injury and chemical irritation of the mesentery caused by intestinal rupture. The streaky density appears to be a significant finding for small intestinal rupture.