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Traumatic bowel and mesenteric injuries

Case contributed by Henry Knipe
Diagnosis certain

Presentation

Motor vehicle accident

Patient Data

Age: 35 years
Gender: Male

The liver, spleen, pancreas, gallbladder, kidneys and adrenal glands all have a normal appearance.

Colon in the left lower quadrant is surrounded by mild fat stranding and is relatively thick-walled compared to other colon. More inferiorly there is mesenteric hyperdensity (50HU) extending inferiorly. Atypical position of the cecum in the midline with colon predominantly on the left and duodenum does not pass the midline with small bowel being present on the right; reversed SMA/SMV relationship. Small volume of pelvic free fluid. No free gas.

Anterior pelvic subcutaneous fat stranding. No pelvic fracture identified.

Conclusion:

Appearances of bowel in the left lower quadrant and pelvic free fluid are suspicious for large bowel injury. Probable mesenteric hematoma. Note, there is intestinal malrotation.

 

Annotated image

Yellow arrow - injured bowel (slightly thick-walled with adjacent fat stranding)

Blue arrow - mesenteric hematoma

Case Discussion

Patient proceeded for trauma laparotomy which confirmed large bowel injury (multiple transverse colon serosal tears) and mesenteric hematoma. 

Bowel injuries are often occult on CT and when demonstrated can be subtle and a combination of factors such as fat stranding, mesenteric hypderdensity and pelvic free fluid. 

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