Presentation
Patient presented to ER after road traffic accident
Patient Data
Long segment bowel wall thickening is seen involving the proximal ileal loop. A large rent (size – 1.2 cm) is seen in the wall of the proximal ileal loop with extravasation of bowel contents into the peritoneal cavity.
• A suspicious tiny rent is seen in the distal jejunal loop.
• Pneumoperitoneum present.
• Moderate free fluid is seen.
Case Discussion
Discontinuous bowel wall is a specific and direct sign of bowel injury on MDCT; however picking up this sign is very difficult and has a sensitivity of 5% to 10 %.
Another direct sign is free air which is also present in this case.
Indirect signs include abnormal bowel wall enhancement, focal wall thickening, free fluid, mesenteric infiltration and extravasation of contrast material (routine administration of oral contrast material is not warranted in patients with blunt abdominal trauma).
History plays a important role in determining the appropriate imaging examination for evaluation perforated viscus.Other causes of perforation include ischemia, infection, autoimmune, diverticular disease, and malignant diseases.
At laparotomy, a small-bowel perforation was confirmed that required resection.