Blunt Injury of the Bowel and Mesentery

Purpose of Review

Although not common, blunt bowel and mesenteric trauma requires prompt identification and intervention to avoid significant morbidity and mortality.

Recent Findings

Developments in MDCT technology especially with 64 and higher slice MDCT have improved image quality for better detection and depiction of bowel and mesenteric injury. Recent reports indicate that administration of oral contrast does not increase diagnostic accuracy, allowing for more rapid door to scan time. Dual-source CT (DS-CT) ability to generate iodine maps and virtual noncontrast images has the potential to increase conspicuity of bowel perfusion abnormalities, better distinguish hypo-perfused from nonperfused bowel, and reveal bowel wall hematoma obscured by mural enhancement.

Summary

This article will review the current state-of-the-art approach in using direct and indirect MDCT signs of bowel injury in an attempt to differentiate surgical from nonsurgical lesions, and discuss imaging protocols used at our institution for follow-up imaging in nonsurgical lesions. We will also demonstrate the potential utility of DS-CT in blunt bowel injury.