Computed tomography in the diagnosis of blunt intestinal and mesenteric injuries

Twenty-four patients with signs on computed tomography (CT) of mesenteric or intestinal injury were treated over a 5-year period (1980—1984). All patients were the victims of blunt abdominal trauma. Nine patients with CT evidence of mesenteric or bowel hematomas were observed without adverse outcome. Fifteen were operatively explored, with 14 having injuries similar to the findings on the preoperative CT scans. In the group that had surgery, either thickened bowel or free intraperitoneal fluid (blood or less dense fluid) or both were present in all but one patient. Extraluminal air (three cases) or Gastrografin (Squibb) (one case) were absolute indications for surgery, as were bowel wall or mesenteric hematomas accompanied by substantial amounts of intraperitoneal fluid. The patient’s history, physical examination, and initial laboratory values are important in proper selection of patients for CT evaluation. We feel that CT appears to offer certain definite advantages over peritoneal lavage in evaluation of bowel and mesenteric injuries and can reliably help to distinguish the injuries that require surgical repair from those that can be safely monitored and observed.