Hypoperfusion complex - "shock bowel"


Hypoperfusion complex due to blood loss and prolonged hypotension following an upper extremity injury. It reflects the body's sympathetic response to hypotension, and in this case, has the following manifestations:

  • shock bowel (splanchnic vasoconstriction results in increased mucosal permeability, resulting in leakage and mural interstitial fluid and contrast) 
  • hyperenhancing gallbladder wall 
  • small spleen
  • persistent nephrogram
  • peripancreatic fluid
  • flattened IVC
  • small aorta
  • ascites

Of note, a recent article supports that decreased splenic volume is actually the most sensitive indicator of hypoperfusion complex (34 of 35 patients with prior imaging had >30% decrease in volume). On average, patients with hypovolemic shock complex splenic volume was 107 mL, compared to 220 mL in the control population1.