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CT Hypotension Complex (Shock Bowel) Is Not Always Due to Traumatic Hypovolemic Shock

¹ Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA.
² Present address: Department of Radiology, Stanford University, 300 Pasteur Dr., Stanford, CA 94305.

OBJECTIVE. The purpose of our study was to review the clinical and CT findings in a substantial series of 41 patients with the shock bowel sign to determine if there is an association between shock bowel (and other CT signs of hypotension) and conditions other than post-traumatic hypovolemic shock.

CONCLUSION. The shock bowel sign and the CT hypotension complex are frequently associated with hypotension from causes other than trauma-induced hypovolemic shock, such as severe head or spine injury, cardiac arrest, septic shock, bacterial endocarditis, and diabetic ketoacidosis. Other elements of the CT hypotension complex such as flattening of the inferior vena cava and aorta, abnormal pancreatic enhancement and peripancreatic fluid, and hypoperfusion of the spleen and liver are variably associated with shock bowel whether due to posttraumatic hypovolemia or other causes of hypotension. The CT hypotension complex (shock bowel) has important prognostic and therapeutic implications and can probably be distinguished from bowel trauma and other forms of bowel injury in most cases.

Keywords: hypotension • hypovolemic shock complex • shock bowel • trauma

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