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.
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

OBJECTIVE: To evaluate the usefulness of plain abdominal radiography as an evaluation method for bowel dysfunction in patients with spinal cord injury (SCI). METHODS: Forty-four patients with SCI were recruited. Patients were interviewed about their clinical symptoms, and the constipation score and Bristol stool form scale were assessed. The colon transit time (CTT) was measured by using radio-opaque markers (Kolomark). The degree of stool retention and the presence of megacolon or megarectum were evaluated using plain abdominal radiographs. We examined the relationship between clinical aspects and CTT and plain abdominal radiography. RESULTS: The constipation scores ranged from 1 to 13, and the average was 4.19+/-3.11, and the Bristol stool form scale ranged from 1 to 6, with an average of 4.13+/-1.45. CTTs were 19.3+/-16.17, 19.3+/-13.45, 15.32+/-13.15, and 52.42+/-19.14 in the right, left, rectosigmoid, and total colon. Starreveld scores were 3.4+/-0.7, 1.8+/-0.86, 2.83+/-0.82, 2.14+/-1, and 10.19+/-2.45 in the ascending, transverse, descending, rectosigmoid, and total colon. Leech scores were 3.28+/-0.7, 2.8+/-0.8, 2.35+/-0.85, and 8.45+/-1.83 in the right, left, rectosigmoid, and total colon. The number of patients with megacolon and megarectum was 14 (31.8%) and 11 (25%). There were statistically significant correlations between the total CTT and constipation score (p<0.05), and Starreveld and Leech scores (p<0.05). Significant correlations were observed between each segmental CTT and the segmental stool retention score (p<0.05). CONCLUSION: Plain abdominal radiography is useful as a convenient and simple method of evaluation of bowel dysfunction in patients with SCI.
Colon ; Constipation ; Humans ; Megacolon ; Neurogenic Bowel ; Radiography, Abdominal ; Retention (Psychology) ; Spinal Cord ; Spinal Cord Injuries

We report a rare case of traumatic abdominal wall hernia (TAWH) caused by a traffic accident. A 47-year-old woman presented to the emergency room soon after a traffic accident. She complained of diffuse, dull abdominal pain and mild nausea. She had no history of prior abdominal surgery or hernia. We found a bulging mass on her right abdomen. Plain abdominal films demonstrated a protrusion of hollow viscus beyond the right paracolic fat plane. Computed tomography (CT) showed intestinal herniation through an abdominal wall defect into the subcutaneous space. She underwent an exploratory surgery, followed by a layer-by-layer interrupted closure of the wall defect using absorbable monofilament sutures without mesh and with no tension, despite the large size of the defect. Her postoperative course was uneventful.
Abdominal Injuries/complications ; Abdominal Wall/pathology/*surgery ; Female ; Hernia, Abdominal/etiology/radiography/*surgery ; Humans ; Middle Aged ; Tomography, X-Ray Computed ; Treatment Outcome

PURPOSE: Traumatic diaphragmatic rupture resulting from blunt trauma is usually severe. However, it is often overlooked during initial evaluation because there are no characteristic signs and symptoms. Thus, this study aimed to determine the clinical characteristics of diaphragmatic rupture caused by blunt trauma and investigate the diagnostic usefulness of diaphragmatic height index (DHI) measured using chest radiographs. METHODS: The cohort comprised patients who were admitted due to diaphragmatic rupture from blunt trauma. Patients were divided into 2 groups; the control group comprised patients with blunt trauma who were matched for age, sex, and Injury Severity Score, while the DHI group comprised patients with diaphragmatic rupture from blunt trauma. Receiver operating characteristic curve was used to determine the cutoff value of DHI for diaphragmatic injury. The sensitivity, specificity, predictability, accuracy, and likelihood ratio of the cutoff were then determined. RESULTS: A total of 60 patients were confirmed to have diaphragmatic rupture. The mean DHI in patients with diaphragmatic rupture on the right and left side were both significantly different compared to that in the control group. A DHI cutoff value of >1.31 showed 71% sensitivity and 87% specificity for diagnosing right diaphragmatic rupture, while a cutoff value of <0.43 showed 87% sensitivity and 76% specificity for diagnosing left diaphragmatic rupture. CONCLUSION: DHI can be useful in the diagnosis of diaphragmatic rupture. DHI as determined using chest radiographs in patients with blunt abdominal trauma, particularly in those ineligible for diagnostic work-up, may help in the diagnosis of diaphragmatic rupture.
Abdominal Injuries ; Cohort Studies ; Diagnosis ; Diaphragm ; Humans ; Injury Severity Score ; Multiple Trauma ; Radiography, Thoracic ; ROC Curve ; Rupture ; Sensitivity and Specificity

We present a case of thoracic splenosis in a 42-yr-old man with a medical history of abdominal surgery for a penetration injury with an iron bar of the left abdomen and back. He had been in good condition, but a chest radiograph taken during a regular checkup showed a multinodular left pleura-based mass. Computed tomography (CT) showed that the mass was well-enhanced and homogeneous, indicating a sclerosing hemangioma. Following its removal by video-assisted thoracoscopic surgery, the mass appeared similar to a hemangioma, with marked adhesion to the left side diaphragmatic pleura and lung parenchyma. Frozen section showed that the lesion was a solid mass consisted with abundant lymphoid cells, suggesting a low grade lymphoma. On permanent section, however, the mass was found to be composed of white pulp, red pulp, a thick capsule and trabeculae and was diagnosed as ectopic splenic tissue, or thoracic splenosis. Review of the patient's history and chest CT at admission revealed that the patient had undergone a splenectomy for the penetration injury 20 yr previously.
Abdominal Injuries/complications ; Adult ; Diagnosis, Differential ; Humans ; Male ; Medical Records ; Spleen/injuries/surgery ; Splenectomy ; Splenosis/*diagnosis/etiology/radiography ; Thoracic Diseases/*diagnosis/etiology/radiography ; Thoracic Surgery, Video-Assisted ; Tomography, X-Ray Computed

We report 2 cases of complicated spontaneous dissection of the celiac artery, which were successfully treated by a stent graft. The first patient was a 47-year-old man who presented with acute abdominal pain. CT scan showed ruptured saccular aneurysm with surrounding retroperitoneal hematoma. The second patient was a 57-year-old man with progressive dissecting aneurysm. Endovascular stent graft was placed in the celiac trunk to control bleeding, and to prevent rupture in each patient. Follow-up CT scans showed complete obliteration of a dissecting aneurysm.
Abdominal Pain/etiology/radiography ; Aneurysm, Dissecting/*therapy ; Aneurysm, Ruptured/prevention & control ; Celiac Artery/*injuries ; Hematoma/etiology/radiography ; Hemorrhage/etiology/radiography ; Humans ; Male ; Middle Aged ; Retroperitoneal Space ; Rupture, Spontaneous/therapy ; *Stents ; Tomography, X-Ray Computed/adverse effects

The aim of this study was to investigate features of abdominal earthquake-related crush traumas in comparison with non-earthquake injury. A cross sectional survey was conducted with 51 survivors with abdominal crush injury in the 2008 Sichuan earthquake, and 41 with abdominal non-earthquake injury, undergoing non-enhanced computed tomography (CT) scans, serving as earthquake trauma and control group, respectively. Data were analyzed between groups focusing on CT appearance. We found that injury of abdominal-wall soft tissue and fractures of lumbar vertebrae were more common in earthquake trauma group than in control group (28 vs 13 victims, and 24 vs 9, respectively; all P < 0.05); and fractures were predominantly in transverse process of 1-2 vertebrae among L1-3 vertebrae. Retroperitoneal injury in the kidney occurred more frequently in earthquake trauma group than in control group (29 vs 14 victims, P < 0.05). Abdominal injury in combination with thoracic and pelvic injury occurred more frequently in earthquake trauma group than in control group (43 vs 29 victims, P < 0.05). In conclusion, abdominal earthquake-related crush injury might be characteristic of high incidence in injury of abdominal-wall soft tissue, fractures of lumbar vertebrae in transverse process of 1-2 vertebrae among L1-3 vertebrae, retroperitoneal injury in the kidney, and in combination with injury in the thorax and pelvis.
Abdominal Injuries/*radiography ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Cross-Sectional Studies ; Disasters ; *Earthquakes ; Female ; Humans ; Male ; Middle Aged ; Tomography Scanners, X-Ray Computed

Adult ; Cecum ; diagnostic imaging ; injuries ; pathology ; Colonoscopy ; methods ; Foreign-Body Migration ; diagnostic imaging ; etiology ; surgery ; Humans ; Iatrogenic Disease ; Male ; Needles ; Radiography, Abdominal

The increased use of interventional procedures and laparoscopic cholecystectomy in the management of hepatobiliary disorders is associated with an increased incidence of hemobilia and hepatic artery aneurysm. Here we report a case of hepatic artery pseudoaneurysm associated with a plastic biliary stent. Multiple factors were involved in the formation of the hepatic artery aneurysm (HAA) and it was successfully treated by embolization.
Aneurysm, False/etiology/*therapy ; Biliary Tract Surgical Procedures/adverse effects ; Embolization, Therapeutic/methods ; Female ; Hemobilia/etiology/therapy ; Hepatic Artery/*pathology/radiography ; Humans ; Middle Aged ; *Stents ; Abdominal Injuries/complications ; Abdominal Wall/pathology/*surgery ; Female ; Hernia, Abdominal/etiology/radiography/*surgery ; Humans ; Middle Aged ; Tomography, X-Ray Computed ; Treatment Outcome

Therapeutic paracentesis is considered to be a relatively safe procedure and is performed commonly for the control of massive ascites in patients with liver cirrhosis. The commonest puncture site, approximately 4 or 5 cm medial of left anterior superior iliac spine, can be located across the route of the inferior epigastric artery, which is one of the sites of potential massive bleeding. In a 46-year-old woman with liver cirrhosis and refractory ascites, a huge abdominal wall hematoma developed after therapeutic paracentesis. The patient was not stabilized by conservative treatment, and inferior epigastric artery injury was confirmed on angiography. Angiographic coil embolization of the inferior epigastric artery was conducted, after which the bleeding ceased and the hematoma stopped growing. This case indicates that physicians performing paracentesis should be aware of the possibility of inferior epigastric artery injury and consider early angiographic coil embolization when a life-threatening abdominal wall hematoma develops.
Abdominal Wall ; Angiography ; Ascites/surgery ; Embolization, Therapeutic ; Epigastric Arteries/*injuries ; Female ; Hematoma/*etiology/radiography/therapy ; Humans ; Liver Cirrhosis/*diagnosis ; Middle Aged ; Paracentesis/*adverse effects ; Tomography, X-Ray Computed ; Wounds, Nonpenetrating/complications