Traumatic bowel injury

Case contributed by Dr Henry Knipe

Presentation

High speed motor vehicle collision. Seatbelt sign.

Patient Data

Age: 37
Gender: Male
CT

Multiple locules of free gas. Low-density (10 HU) free fluid within the pelvis and both paracolic gutters. Fat stranding surrounds colon at the junction of descending/sigmoid in the left lower quadrant. Ileal loops in the right lower quadrant have hyperenhancing walls. Extensive subcutaneous fat stranding/haematoma of the anterior lateral pelvis and right flank.

Comminuted and displaced fracture of the left ilium, with a fracture line extending to the left sacro-iliac joint. Associated gluteal and iliac muscle haematoma. Small bone fragment anterior to the left sacro-iliac joint is equivocal for fracture (differential is degenerative change).

Annotated image
  • orange arrows = subcutaneous bruising (seatbelt sign)
  • red arrow = free fluid in the right paracolic gutter
  • blue arrow = focal sigmoid colonic wall thickening with pericolonic inflammatory change

Case Discussion

The patient proceeded to laparotomy. Operative findings:

  • perforation in the terminal ileum
  • sigmoid serosal tears

Bowel injuries on CT are often occult and difficult to appreciate. The presence of free gas, in addition to pelvic free fluid and thickened bowel loops increases suspicions substantially. 

PlayAdd to Share

Case information

rID: 35344
Case created: 2nd Apr 2015
Last edited: 1st Apr 2017
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.