Traumatic bowel and mesenteric injuries

Case contributed by Dr Henry Knipe

Presentation

MVA

Patient Data

Age: 33
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 caecum 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 haematoma. Note, there is intestinal malrotation.

 

Annotated image

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

Blue arrow - mesenteric haematoma

Case Discussion

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

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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Case information

rID: 28656
Case created: 5th Apr 2014
Last edited: 6th Sep 2015
Inclusion in quiz mode: Included

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