Pearls and pitfalls in the imaging of blunt bowel and mesenteric injury

Blunt bowel and mesenteric injury (BBMI) in the setting of trauma remains an underrecognized entity, and delays in diagnosis can significantly affect patient outcomes. Clinical findings are often unreliable because of associated distracting injuries and the delayed manifestation of abdominal signs. Computed tomography (CT) is the primary imaging modality for detecting blunt bowel and mesenteric injury. CT findings can be categorized into signs of bowel injury, signs of mesenteric injury, and ancillary imaging features that should prompt heightened suspicion for bowel and mesenteric trauma. Bowel findings can be further categorized into hard signs, which generally suggest the need for surgical intervention, and soft signs, which require integration with clinical and laboratory data. Awareness of the pearls and pitfalls of imaging can improve diagnostic confidence, reduce missed findings, and ultimately improve patient outcomes.