Diagnostic accuracy of helical CT for detection of blunt bowel and mesenteric injuries

To determine the diagnostic accuracy of helical computed tomography (CT) in the detection of blunt bowel and mesenteric injury in a clinical setting.

We evaluated the helical CT and surgical findings in 31 patients with blunt abdominal trauma. Nineteen patients had surgically proven bowel and/or mesenteric injury, and 12 patients had no bowel or mesenteric injury at laparotomy. The CT scans were assessed by three observers in consensus and were graded as showing no injury, minor bowel or mesenteric injury (not requiring urgent surgery), or major bowel or mesenteric injury (requiring immediate surgery). The CT diagnoses were compared with the surgical findings.

In the 19 cases of surgically proven bowel injury, CT had an accuracy of 84% (26/31), specificity 84% (16/19), and negative predictive value 89% (16/18) for diagnosis of bowel injury. CT correctly differentiated minor from major bowel injuries in eight of 12 cases (75%). For the 13 cases of mesenteric injury, the accuracy of CT diagnosis was 77% (24/31), specificity 67% (12/18), and negative predictive value 93% (12/13) for diagnosis of mesenteric injury. The CT findings allowed correct differentiation of minor from major mesenteric injuries in seven of 13 cases (54%).

Helical CT is moderately accurate and has a high negative predictive value in detecting bowel and mesenteric injuries after blunt trauma. Helical CT is not highly accurate in predicting the severity of injury or need for urgent surgery.