Hypoperfusion complex - "shock bowel"

Discussion:

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.

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