+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Diffuse small-bowel ischemia in hypotensive adults after blunt trauma (shock bowel): CT findings and clinical significance



Diffuse small-bowel ischemia in hypotensive adults after blunt trauma (shock bowel): CT findings and clinical significance



Ajr. American Journal of Roentgenology 163(6): 1375-1379



The purpose of this study is to describe CT findings of shock bowel (diffuse abnormality of the small bowel observed in hypotensive or hypoperfused patients after blunt abdominal trauma) and to determine the clinical significance of CT-diagnosed shock bowel. A data base search of a radiology data registry indicated 13 patients had CT scans obtained at admission that showed diffuse abnormalities of the small bowel and a corresponding medical history of profound clinical shock preceding CT study. All patients sustained blunt abdominal trauma: nine were involved in motor vehicle collisions, three were struck by motor vehicles, and one had a crushing injury. Vehicular impacts were typically high speed, inducing multisystem injury. Admission and follow-up CT studies were reviewed to characterize and assess the evolution of the abdominal CT findings that occur with shock bowel. Medical records were reviewed to determine blood pressure at the accident scene or on admission, surgical findings, and patient outcome. All patients were severely hypotensive in the field or on admission; three were in cardiac arrest at the scene of the accident. CT scans showed diffuse thickening of the small-bowel wall in all patients, ranging from 7 mm to 15 mm (mean, 11 mm); fluid-filled, dilated small bowel in nine patients; subjectively increased contrast enhancement of the small-bowel wall in six patients; and a flattened inferior vena cava (< 9 mm anteroposterior diameter at renal veins) in 10 patients. The colon appeared normal in all cases. Celiotomy in eight patients revealed normal-appearing small bowel by inspection in two and localized bowel injuries, with the remaining bowel appearing normal in six. Three patients, including one who had celiotomy, had normal-appearing small bowel on repeat CT scans obtained within 5 days of admission, and three had no clinical evidence of small-bowel disease. Three patients died of causes unrelated to bowel pathology. In trauma patients with hypotension, early abdominal CT may show diffuse abnormalities of the small bowel due to prolonged hypoperfusion--shock bowel--with a normal appearing colon. In this study, the CT findings of shock bowel were reversible and were not associated with clinical symptoms.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 008477418

Download citation: RISBibTeXText

PMID: 7992732

DOI: 10.2214/ajr.163.6.7992732


Related references

Delayed Small Bowel Perforation with Findings of Severe Ischemia Following Blunt Abdominal Trauma. Polish Journal of Radiology 82: 271-274, 2017

Blunt trauma to the gastrointestinal tract: CT findings with small bowel and colon injuries. Emergency Radiology 9(3): 141-145, 2004

Small bowel ischemia caused by strangulation in complicated small bowel obstruction. CT findings in 20 cases with histopathological correlation. Jbr-Btr 94(6): 309-314, 2012

Blunt bowel and mesenteric trauma: role of clinical signs along with CT findings in patients' management. Emergency Radiology 25(5): 461-467, 2018

Diagnostic performance of CT findings for bowel ischemia and necrosis in closed-loop small-bowel obstruction. Abdominal Imaging 40(5): 1097-1103, 2016

Clinical presentation and radiographic identification of small bowel rupture following blunt trauma in children. Pediatric Emergency Care 9(3): 139-142, 1993

Educational Review of Predictive Value and Findings of Computed Tomography Scan in Diagnosing Bowel and Mesenteric Injuries After Blunt Trauma: Correlation With Trauma Surgery Findings in 163 Patients. Canadian Association of Radiologists Journal 68(3): 276-285, 2017

Blunt trauma to the small bowel. International Surgery 55(1): 20-26, 1971

Multidetector CT findings of bowel transection in blunt abdominal trauma. Korean Journal of Radiology 14(4): 607-615, 2014

Small bowel injury following blunt trauma. Pennsylvania Medicine 88(3): 39-40, 1985

Small-bowel obstruction after blunt trauma. Journal of the Royal Society of Medicine 93(9): 498, 2000

Significance of bowel wall enhancement on ct following blunt abdominal trauma. Pediatric Radiology 21(6): 464, 1991

Transient small bowel intussusceptions: ultrasound findings and clinical significance. Abdominal Imaging 31(4): 410-416, 2006

Clinical presentation and radiographic identification of small bowel rupture following blunt trauma in children: Ford EG, Senac MO Pediatr Emerg Care 9:139142 Jun 1993. Annals of Emergency Medicine 22(11): 1780-1781, 1993

Small bowel strictures after blunt abdominal trauma. British Journal of Surgery 69(4): 236-236, 1982