Korean J Radiol.  2013 Aug;14(4):607-615. 10.3348/kjr.2013.14.4.607.

Multidetector CT Findings of Bowel Transection in Blunt Abdominal Trauma

• Cho HS
• Woo JY
• Hong HS
• Park MH
• Ha HI
• Yang I
• Lee Y
• Jung AY
• Hwang JY

• KMID: 1715765
• DOI: http://doi.org/10.3348/kjr.2013.14.4.607

Abstract

OBJECTIVE
Though a number of CT findings of bowel and mesenteric injuries in blunt abdominal trauma are described in literature, no studies on the specific CT signs of a transected bowel have been published. In the present study we describe the incidence and new CT signs of bowel transection in blunt abdominal trauma.
MATERIALS AND METHODS
We investigated the incidence of bowel transection in 513 patients admitted for blunt abdominal trauma who underwent multidetector CT (MDCT). The MDCT findings of 8 patients with a surgically proven complete bowel transection were assessed retrospectively. We report novel CT signs that are unique for transection, such as complete cutoff sign (transection of bowel loop), Janus sign (abnormal dual bowel wall enhancement, both increased and decreased), and fecal spillage.
RESULTS
The incidence of bowel transection in blunt abdominal trauma was 1.56%. In eight cases of bowel transection, percentage of CT signs unique for bowel transection were as follows: complete cutoff in 8 (100%), Janus sign in 6 (100%, excluding duodenal injury), and fecal spillage in 2 (25%). The combination of complete cutoff and Janus sign were highly specific findings in patients with bowel transection.
CONCLUSION
Complete cut off and Janus sign are the unique CT findings to help detect bowel transection in blunt abdominal trauma and recognition of these findings enables an accurate and prompt diagnosis for emergency laparotomy leading to reduced mortality and morbidity.

Keyword

MDCT; Blunt abdominal trauma; Bowel transection

MeSH Terms

Abdominal Injuries/*radiography
Adult
Female
Humans
Intestines/*injuries/radiography
Male
Middle Aged
Multidetector Computed Tomography/*methods
Reproducibility of Results
Retrospective Studies
Rupture
Wounds, Nonpenetrating/*radiography

Figure

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  Fig. 1 Flow chart of patient selection in this study.

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  Fig. 2 Janus sign. A. Axial contrast enhanced multidetector CT scan shows well enhancing distal jejunal loop (white arrow) and continuous bowel loop shows no enhancement abruptly (black arrow). Most of patients with bowel transection show this appearance in MDCT and we named it Janus sign. B. Janus is two-faced god in Roman mythology.

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  Fig. 3 MDCT findings of jejunal segmental transection of 42-year-old man. A. Axial contrast enhanced multidetector CT scan which was taken 1 hour after trauma shows focal dissection of right common iliac artery (arrow) and there is diffuse hematoma surrounding lesion. By focusing on this focal dissection, mesenteric hematoma around dissection was mistakenly thought to have originated from great vessel injury. B. Coronal reformatted contrast enhanced multidetector CT scan shows complete cut off of bowel loop at distal jejunum; complete cut off sign (open arrow). Jejunal loop shows abnormal dual bowel wall enhancement (both increased and decreased), and loses continuity soon after; Janus sign (arrows). Other end of broken bowel loop is identified nearby (arrowheads). C. Axial contrast enhanced multidetector CT scan presents 10 cm-long fragmented bowel segment in pelvic cavity (arrow). This fragmented bowel segment had no connection with adjacent bowel loop. There is no wall enhancing compared to normal enhanced bowel wall (arrowhead). D. Second axial contrast enhanced multidetector CT, taken 17 hours after trauma, shows free air (arrow) and increased amount of fluid (arrowhead) in abdomen. At first CT scans (A-C), there was no free air.

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  Fig. 4 MDCT findings of multiple small bowel transections of 47-year-old woman. A. Sagittal reformatted contrast enhanced multidetector CT scan shows complete cut off of bowel loop at proximal ileum. Ileal loop shows abnormal dual bowel wall enhancement (both increased and decreased); Janus sign (arrows). Surrounding hematoma (arrowhead) makes it difficult to recognize transected bowel end. B, C. Axial contrast enhanced multidetector CT scans show mesenteric extravasation (arrow in B), mesenteric hematoma (arrowhead in B) and lateral hernia of ascending colon (arrow in C).

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  Fig. 5 MDCT findings of duodenal transection of 37-year-old man. A. Coronal reformatted contrast enhanced multidetector CT scan shows transection of third portion of duodenum (arrow). B. Axial contrast enhanced multidetector CT scan of duodenum around transection shows hyperenhancing mucosa, representing shock bowel (arrow).

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  Fig. 6 MDCT findings of distal ileal transection of 54-year-old man. A, B. Axial and coronal reformmated contrast enhanced multidetector CT scans show transection of distal ileum and fecal spillage (arrow in A, B).

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