目的:剖腹手术可以发现1.2%-5%的闭合性腹部创伤患者的肠和肠系膜损伤。在这种情况下,延迟诊断与持续败血症的风险增加密切相关。随后发病率和死亡率更高。计算机断层扫描(CT)扫描是评估腹部钝性外伤的金标准,在血流动力学稳定的创伤患者的情况下,准确诊断肠和肠系膜损伤。本研究的目的是1)在闭合性腹部创伤后肠和肠系膜损伤的情况下,回顾CT征象与术中发现之间的相关性,根据我们对25例小肠和肠系膜损伤(SBMI)的创伤患者的经验,分析放射学特征与术中发现的相关性;2)确定在CT上发现的那些体征的诊断特异性,并考虑以下临床处理的实际考虑;3)将需要立即手术干预的肠和肠系膜损伤与接受初始非手术治疗的肠和肠系膜损伤区分开来。
方法:在2008年1月1日至2010年5月31日之间,有163例患者在腹部钝性外伤后需要进行剖腹手术。其中,25例患者出现肠或肠系膜损伤。数据进行了回顾性分析,将手术报告与术前CT检查结果相关联。
结果:我们正在对CT扫描时肠道和肠系膜病变的重要和频繁发现进行图片回顾,在开腹手术中证实。此外,评估CT扫描对SBMI的预测价值.
结论:多探测器CT扫描是评估腹内钝性腹部创伤的金标准,不仅用于实质器官损伤,而且还用于检测SBMI;在存在特定体征的情况下,它可以准确评估中空内脏损伤,帮助创伤外科医生选择正确的初始临床管理。
OBJECTIVE: Laparotomy can detect bowel and mesenteric injuries in 1.2%-5% of patients following blunt abdominal trauma. Delayed diagnosis in such cases is strongly related to increased risk of ongoing sepsis, with subsequent higher morbidity and mortality. Computed tomography (CT) scanning is the gold standard in the evaluation of blunt abdominal trauma, being accurate in the diagnosis of bowel and mesenteric injuries in case of hemodynamically stable trauma patients. Aims of the present study are to 1)
review the correlation between CT signs and intraoperative findings in case of bowel and mesenteric injuries following blunt abdominal trauma, analysing the correlation between radiological features and intraoperative findings from our experience on 25 trauma patients with small bowel and mesenteric injuries (SBMI); 2) identify the diagnostic specificity of those signs found at CT with practical considerations on the following clinical management; and 3) distinguish the bowel and mesenteric injuries requiring immediate surgical intervention from those amenable to initial nonoperative management.
METHODS: Between January 1, 2008, and May 31, 2010, 163 patients required laparotomy following blunt abdominal trauma. Among them, 25 patients presented bowel or mesenteric injuries. Data were analysed retrospectively, correlating operative surgical reports with the preoperative CT findings.
RESULTS: We are presenting a pictorial
review of significant and frequent findings of bowel and mesenteric lesions at CT scan, confirmed intraoperatively at laparotomy. Moreover, the predictive value of CT scan for SBMI is assessed.
CONCLUSIONS: Multidetector CT scan is the gold standard in the assessment of intra-abdominal blunt abdominal trauma for not only parenchymal organs injuries but also detecting SBMI; in the presence of specific signs it provides an accurate assessment of hollow viscus injuries, helping the trauma surgeons to choose the correct initial clinical management.