Presentation
Patient was involved in a high speed motor vehicle accident, where the car he was driving rolled over. A CT trauma series was performed.
Patient Data
- "Shock bowel" involving the stomach, duodenum, jejunum and proximal sigmoid colon.
- There is evidence of pulmonary interstitial edema - Increased interstitial opacities on the right with patchy ground-glass appearance as well as on the left in a more peripherally distributed pattern would be in keeping with interstitial edema secondary to fluid overload from aggressive resuscitation. Multiple subpleural opacities in the posterior aspect of the left hemithorax are likely to represent focal subsegmental atelectasis.
- Large amount of intraperitoneal free fluid.
- Left femoral arterial line, femoral central venous catheter, indwelling urinary catheter and nasogastric tube are in a satisfactory position.
Case Discussion
The main finding for this case is that of shock bowel.
Shock bowel is a radiological phenomenon which is often found in patients who are severely hypotensive post trauma. It is characterized by bowel segments with submucosal edema and intense mucosal enhancement 1.
Treatment of shock bowel is usually supportive. Without appropriate support, it has significant clinical implications as untreated shock bowel can have a mortality of up to 70% 2. Moreover, its radiological appearance can sometimes be confused with traumatic bowel injury and bowel ischemia - conditions which mandate immediate operative management.
In this patient, the loops of bowel appear edematous, enhance heterogeneously and appear 'rippled' in nature. This is a classical feature of shock bowel.
Case contributed by A/Prof. Pramit Phal.