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[Secondary peritonitis after negative computerized tomography in blunt abdominal trauma]
1Universitätsklinik für Viszerale und Transplantationschirurgie, Inselspital Bern.
Helvetica Chirurgica Acta
|April 1, 1994
Summary
Computed tomography (CT) has limitations in detecting small bowel injuries after blunt abdominal trauma. These injuries may be missed by CT, leading to delayed diagnosis of peritonitis.
Area of Science:
- Radiology
- Trauma Surgery
- Emergency Medicine
Background:
- Diagnostic peritoneal lavage is largely replaced by emergency sonography for blunt abdominal trauma.
- Computed tomography (CT) is crucial for evaluating hemodynamically stable patients, assessing parenchymal organ injuries, and defining retroperitoneal, spinal, and pelvic lesions.
Observation:
- CT demonstrates good results for specific indications but has low sensitivity for detecting hollow viscus injuries.
- Three cases of small bowel lesions (2 perforations, 1 mesenteric/ischemic injury) were not identified on CT, even retrospectively.
- These injuries presented with subtle clinical signs and were diagnosed late, upon the development of overt secondary peritonitis.
Findings:
- CT imaging has limitations in visualizing small bowel perforations and mesenteric injuries in blunt abdominal trauma.
- Delayed diagnosis of hollow viscus injuries can occur despite initial CT evaluation.
- Retrospective analysis failed to identify these specific small bowel lesions on CT scans.
Implications:
- Clinicians must remain aware of CT's limitations in diagnosing visceral injuries in blunt abdominal trauma.
- The possibility of missed small bowel lesions should be considered in patients with blunt abdominal trauma, especially with evolving clinical signs.
- Further diagnostic considerations or close clinical monitoring may be necessary when CT findings are inconclusive for hollow viscus injury.