Occult bowel injury after blunt abdominal trauma

• Published in: The American journal of surgery 2019-08, Vol.218 (2), p.266-270
• Main Authors: Loftus, Tyler J., Morrow, Megan L., Lottenberg, Lawrence, Rosenthal, Martin D., Croft, Chasen A., Smith, R. Stephen, Moore, Frederick A., Brakenridge, Scott C., Borrego, Robert, Efron, Philip A., Mohr, Alicia M.
• Format: Article
• Language: English
• Subjects: Abdomen; Abdominal Injuries - complications; Abdominal surgery; Adhesions; Adhesives; Adult; Bowel injury; Computed tomography; Exploration; Female; Humans; Inflammation; Injuries; Intestine; Intestines - diagnostic imaging; Intestines - injuries; Laparoscopy; Male; Medical imaging; Middle Aged; Missed Diagnosis; Patients; Retrospective Studies; Surgery; Tomography; Tomography, X-Ray Computed; Trauma; Wounds, Nonpenetrating - complications
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2018.11.018

Following blunt abdominal trauma, bowel injuries are often missed on admission computed tomography (CT) scan. Multicenter retrospective analysis of 176 adults with moderate-critical blunt abdominal trauma and admission CT scan who underwent operative exploration. Patients with a bowel injury missed on CT (n = 36, 20%) were compared to all other patients (n = 140, 80%). The missed injury group had greater incidence free fluid without solid organ injury on CT scan (44% vs. 25%, p = 0.038) and visceral adhesions (28% vs. 6%, p = 0.001). Independent predictors of missed bowel injury included prior abdominal inflammation (OR 3.74, 95% CI 1.37–10.18), CT evidence of free fluid in the absence of solid organ injury (OR 2.31, 95% CI 1.03–5.19) and intraoperative identification of visceral adhesions (OR 4.46, 95% CI 1.52–13.13). Patients with visceral adhesive disease and indirect evidence of bowel injury on CT scan were more likely to have occult bowel injury. •Occult bowel injury after blunt trauma is common and delayed diagnosis is morbid.•At two centers, the incidence of bowel injury missed on admission CT scan was 20%.•Free fluid without solid organ injury was associated with occult bowel injury.•Visceral adhesions were associated with occult bowel injury. Following blunt abdominal trauma, bowel injuries are often missed on admission computed tomography (CT) scan. In this multicenter retrospective analysis of 176 adults with moderate-critical blunt abdominal trauma and admission CT scan who underwent operative exploration, patients with visceral adhesive disease and indirect evidence of bowel injury on CT scan were more likely to have occult bowel injury.