MDCT of Blunt Abdominal Trauma: The Correlation of Extraluminal Air, Fluid, and Unexplained Fluid with Bowel Perforation

腹部創傷病患的多層螺旋電腦斷層：腹腔腸道外空氣，液體以及來源無法解釋的液體和腹部鈍傷造成腸穿孔的相互關係

顧逸康(Yi-Kang Ku) ； 黃耀祥(Yon-Cheong Wong) ； 王俐人(Li-Jen Wang) ； 方禎鋒(Jen-Feng Fang) ； 林炳川(Being-Chuan Lin)

《中華放射線醫學雜誌》 32卷2期 (2007/06) Pp. 57-62

摘要

To correlate blunt bowel perforation with CT findings of extraluminal air, extraluminal fluid, and unexplained extraluminal fluid and determine their diagnostic values.
During a study period of 30 months, the CT findings of 394 patients with abdominal trauma were prospectively recorded. A retrospective chart review of these patients for bowel injuries, choice of treatments, and final outcome was performed. The correlation of bowel perforation with CT findings of extraluminal air, extraluminal fluid, and unexplained extraluminal fluid was computed. The diagnostic values and likelihood ratios of these CT findings were determined.
Among 394 CT scans, 22 had extraluminal air, 259 had extraluminal fluid, 82 had unexplained extraluminal fluid. Blunt bowel perforat ion occurred in 24 (6.1%) patients and was significantly correlated with extraluminal air (68.2% vs. 2.4%, p＜0.001), extraluminal fluid (8.9% vs. 0.7%, p=0.001), as well as unexplained extraluminal fluid (23.2% vs. 2.3%, p＜0.001). The likelihood ratio of positive extraluminal air, extraluminal fluid, and unexplained extraluminal fluid for bowel perforation was 32.9, 1.5, and 3.1 respectively. Extraluminal air had the highest specificity (98.1%) but low sensitivity (62.5%), extraluminal fluid had the highest sensitivity (95.8%) but low specificity (36.2%). By comparison, unexplained fluid in the absence of solid organ injury had a higher specificity than unspecified extraluminal fluid (73.3% vs. 36.2%).
The presence of extraluminal air or fluid on trauma CT is significantly correlated with blunt bowel perforation. Extraluminal air is specific and warrants immediate surgical attention, whereas unexplained fluid should initiate aggressive work-up such as diagnostic peritoneal lavage for clarifying bowel perforation.

並列摘要

To correlate blunt bowel perforation with CT findings of extraluminal air, extraluminal fluid, and unexplained extraluminal fluid and determine their diagnostic values.
During a study period of 30 months, the CT findings of 394 patients with abdominal trauma were prospectively recorded. A retrospective chart review of these patients for bowel injuries, choice of treatments, and final outcome was performed. The correlation of bowel perforation with CT findings of extraluminal air, extraluminal fluid, and unexplained extraluminal fluid was computed. The diagnostic values and likelihood ratios of these CT findings were determined.
Among 394 CT scans, 22 had extraluminal air, 259 had extraluminal fluid, 82 had unexplained extraluminal fluid. Blunt bowel perforat ion occurred in 24 (6.1%) patients and was significantly correlated with extraluminal air (68.2% vs. 2.4%, p＜0.001), extraluminal fluid (8.9% vs. 0.7%, p=0.001), as well as unexplained extraluminal fluid (23.2% vs. 2.3%, p＜0.001). The likelihood ratio of positive extraluminal air, extraluminal fluid, and unexplained extraluminal fluid for bowel perforation was 32.9, 1.5, and 3.1 respectively. Extraluminal air had the highest specificity (98.1%) but low sensitivity (62.5%), extraluminal fluid had the highest sensitivity (95.8%) but low specificity (36.2%). By comparison, unexplained fluid in the absence of solid organ injury had a higher specificity than unspecified extraluminal fluid (73.3% vs. 36.2%).
The presence of extraluminal air or fluid on trauma CT is significantly correlated with blunt bowel perforation. Extraluminal air is specific and warrants immediate surgical attention, whereas unexplained fluid should initiate aggressive work-up such as diagnostic peritoneal lavage for clarifying bowel perforation.