Small-Bowel and Mesenteric Injuries in Blunt Trauma of the Abdomen

Bowel and mesentery are injured in an estimated 1%-5% of cases after blunt trauma [1e3] and is the third most common type of injury from blunt trauma to abdominal organs [4e7]. There are 3 basic mechanisms that govern injury to bowel and mesentery, and include direct crushing force, shearing force, and a sudden increase in intraluminal pressure that results in burst injuries [8]. Missed or delayed diagnosis is multifactorial. Symptoms may be absent on initial presentation and, when present, may be nonspecific. Furthermore, clinical assessment of some patients may not be reliable in the presence of concomitant injuries. The result of these undiagnosed injuries is increased morbidity and mortality [2,9e13]. Diagnostic tests in patients with suspected abdominal injury include peritoneal lavage, ultrasonography, and computed tomography (CT). Although sensitivity of peritoneal lavage for detection of hemoperitoneum is higher than 90% [14e16], it is neither specific nor sensitive, with undetected bowel perforation seen in up to 10% of cases [17]. Focused ultrasound assessment in trauma has a sensitivity of 86% for detection of free intra-abdominal fluid but is nonspecific with regard to organ injury [18]. In comparison, multidetector CT is more sensitive and specific than diagnostic peritoneal lavage, abdominal ultrasound, and clinical examination for the diagnosis of bowel and mesenteric injuries [19], with improved diagnostic accuracy making it the imaging modality of choice for evaluation of abdominal and pelvic trauma [20e29].