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Performance of CT in Detection of Bowel Injury

¹ All authors: Department of Radiology, University of Pittsburgh Medical Center-Presbyterian Hospital, 200 Lothrop St., Pittsburgh, PA 15213.

View larger version (125K): [in a new window]   Fig. 1A. —46-year-old woman who presented with jejunal laceration with active hemorrhage sustained during automobile crash. CT scan of transverse section through mid abdomen shows jejunal segments (J) opacified by oral contrast medium. Lower density fluid (F) lies adjacent to bowel loops. High-attenuation fluid (arrow), similar to opacified aorta, indicates active arterial hemorrhage.

View larger version (122K): [in a new window]   Fig. 1B. —46-year-old woman who presented with jejunal laceration with active hemorrhage sustained during automobile crash. CT scan of lower section that A shows more distal jejunal segments (J) are not yet opacified. More free fluid (F) and active bleeding (arrow) are noted.

View larger version (98K): [in a new window]   Fig. 1C. —46-year-old woman who presented with jejunal laceration with active hemorrhage sustained during automobile crash. CT scan photographed at lung window settings clearly shows free intraperitoneal gas (arrow).

View larger version (130K): [in a new window]   Fig. 2A. —74-year-old woman who presented with ileal laceration and mesenteric hemorrhage sustained during automobile crash. Transverse CT section through upper abdomen shows large amount of free peritoneal blood (F) and small, grade 2 splenic lacerations (arrow).

View larger version (132K): [in a new window]   Fig. 2B. —74-year-old woman who presented with ileal laceration and mesenteric hemorrhage sustained during automobile crash. Transverse CT section through lower abdomen reveals active hemorrhage (arrow) within mesentery, triangular collections of blood (F) within leaves of mesentery, abnormal enhancement, and thickening of wall of ileum (I). Free air was noted (not shown). At surgery, wall of ileum was transected and active bleeding was noted in small-bowel mesentery.

View larger version (111K): [in a new window]   Fig. 3A. —65-year-old man who presented with mesenteric hemorrhage sustained during automobile crash. Transverse CT section through mid abdomen shows active hemorrhage (arrow) and mesenteric fluid (F) adjacent to opacified jejunal segments (J). Blood is also present in left paracolic gutter and Morison's pouch.

View larger version (125K): [in a new window]   Fig. 3B. —65-year-old man who presented with mesenteric hemorrhage sustained during automobile crash. More caudal CT section shows triangular mesenteric fluid collections (F) and abnormal enhancement of wall of ileum (I). At surgery, active mesenteric hemorrhage was confirmed and no bowel injury was seen.

View larger version (147K): [in a new window]   Fig. 4. —33-year-old man who presented with duodenal laceration sustained during automobile crash. Transverse CT section through mid abdomen shows retroperitoneal fluid (F) surrounding second portion of duodenum (D).

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