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Value of early repeated abdominal CT in selective non-operative management for blunt bowel and mesenteric injury

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To evaluate the performance of an early repeated computed tomography (rCT) in initially non-operated patients with blunt bowel and mesenteric injuries (BBMI).

Methods

This was a monocentric retrospective observational study from 2009 to 2017 of patients with a BBMI on initial CT (iCT). Patients initially non-operated on were scheduled for a rCT within 48 h. Initial CT and rCT diagnostic performance were compared based on a surgical injury prediction score previously described. For statistical analysis, we used the chi-square analyses for paired data (McNemar test).

Results

Eighty-four patients (1.9% of trauma) had suspected BBMI on iCT. Among these patients, 22 (26.2%) were initially operated on, 18 (21.4%) were later operated on, and 44 (52.4%) were not operated on. The therapeutic laparotomy rate was 85%. Thirty-four patients initially non-operated on had a rCT. The absolute value of the CT scan score increased for 15 patients (44.1%). The early rCT diagnostic performance, compared with iCT, showed an increase in sensitivity (from 63.6 to 91.7%), in negative predictive value (from 77.4 to 94.7%), and in AUC (from 0.77 to 0.94).

Conclusion

In initially non-operated patients with BBMI lesions, the performance of an early rCT improved the sensitivity of lesion detection requiring surgical repair and the security of patient selection for non-operative treatment.

Key Points

• Selective non-operative treatment for hemodynamically stable patients with blunt bowel and/or mesenteric injuries on CT is developing but remains controversial.

• An early repeated CT improved the sensitivity of lesion detection requiring surgical repair and the security of patient selection for conservative treatment.

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Abbreviations

−LR:

Negative likelihood ratio

+LH:

Positive likelihood ratio

AIS:

Abbreviated injury scale

AUC:

Area under the curve

BBMI:

Blunt bowel and/or mesenteric injury

BIPS:

Bowel injury prediction score

FOV:

Field of view

iCT:

Initial computed tomography

IQR:

Interquartile range

ISS:

Injury severity score

NPV:

Negative predictive value

PPV:

Positive predictive value

rCT:

Early repeated computed tomography

ROC:

Receiver operating characteristic

Se:

Sensibility

Sp:

Specificity

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Acknowledgments

The authors would like to thank the Proof-Reading-Service for editing.

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Authors and Affiliations

  1. Aix-Marseille University, Marseille, France

    F. Lannes, U. Scemama, A. Maignan, L. Boyer, K. Chaumoître & M. Leone

  2. Department of General Surgery, APHM, CHU Nord, Marseille, France

    F. Lannes, L. Beyer-Berjot, S. V. Berdah & T. Bège

  3. Department of Radiology, APHM, CHU Nordz, Marseille, France

    U. Scemama & K. Chaumoître

  4. Department of General Surgery, APHM, CHU Timone, Marseille, France

    A. Maignan

  5. Public Health and Chronic Disease Research Unit, APHM, CHU Timone, Marseille, France

    L. Boyer

  6. LBA UMR T24, Aix-Marseille University, Marseille, France

    L. Beyer-Berjot, S. V. Berdah & T. Bège

  7. Department of Anesthesiology and Reanimation, APHM, CHU Nord, Marseille, France

    M. Leone

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  1. F. Lannes
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Correspondence to F. Lannes.

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Guarantor

The scientific guarantor of this publication is Dr. Thierry Bege.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (Laurent Boyer; Aix-Marseille University, Marseille, France; Public Health and Chronic Disease Research Unit, APHM, CHU Timone, Marseille, France) carried out the statistics of this study.

We used computer software (IBM SPSS Statistics, Version 20, USA and XLStat-Premium v.2018.3) to do the statistics.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

• retrospective

• observational

• performed at one institution

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Lannes, F., Scemama, U., Maignan, A. et al. Value of early repeated abdominal CT in selective non-operative management for blunt bowel and mesenteric injury. Eur Radiol 29, 5932–5940 (2019). https://doi.org/10.1007/s00330-019-06212-w

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  • DOI: https://doi.org/10.1007/s00330-019-06212-w

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