Imaging abdomen trauma mesenteric bowel trauma part 6 dr ahmed esawy include different cases for oral radiodiagnosis examination all over the world CT /MRI Plain X ray images blunt abdominal trauma penetrating abdominal trauma fast abdominal ultrasound haemoperitoneum pneumoperitoneum american association of surgeon in trauma AAST SUBCAPSULAR HAEMATOMA PARENCHYMAL LACERATION MESENTERIC HAEMATOMA BOWEL INJURY FREE INTRAPERITONEAL AIR FREE RETROPERITONEAL AIR BOWEL WALL HAEMATOMA MESENTERIC PSEUDOANEURYSM PELVIC HAEMATOMA

2. An Article By
Dr. Ahmed Esawy
MBBS M.Sc MD

4. • BMI can result from both blunt and penetrating
trauma.
• Plain radiograms are useful for evaluating
pneumoperitonium.
• FAST could detects intra-abdominal collections.
• CT is the tool of choice in evaluating BMI.
• Angiography can be used to detect intra-mesentric
hemorrhage.
BOWEL AND MESENTERIC INJURY

6. • Bowel discontinuity disrupted loop:
• Extra luminal air
• Intramural air
• Extraluminal Oral Contrast Material
• Bowel wall thickening
• Bowel wall enhancement
• Mesenteric infiltration
• Intraperitoneal fluid
• Retroperitoneal fluid
CT FINDINGS IN BOWEL MESENTERIC INJURY BMI INJURIES

7. Abdominal CT scan reveals free fluid
(black arrow), free intraperitoneal air(white arrowhead)
, retroperitoneal air (black arrowhead) and
intraperitoneal contrast material (white arrow).

8. Traumatic Duodeno-Jejuneal Perforation
On a CT scan obtained at a lower level, a large
quantity of free contrast material outlines a pelvic
small-bowel loop (white arrows)

9. Abdominal CT scan shows a thick-walled
duodenum (arrow), outlined by extraluminal
retroperitoneal air (arrowheads).

10. CT scan of the pelvis reveals foci of
retroperitoneal air that have escaped from the
duodenal perforation (arrowhead).

11. Abdominal CT scan demonstrates intramural air
in the ileum (solid arrow) and adjacent interloop
free fluid (open arrows

12. CT scan obtained at a lower level shows mucosal
enhancement (arrowhead) of a more distal ileal segment.

13. Traumatic Jejuneal And Mesentric Laceration

14. CT scan obtained at a lower level reveals interloop
fluid (solid arrow) and mesenteric stranding (open
arrow) in the absence of bowel-wall thickening,
findings that are more suggestive of mesenteric injury
than of parenchymal organ damage
Abdominal CT scan shows
hemoperitoneum surrounding the intact
liver capsule (arrowheads).

15. Colonic Laceration with pericolic hematoma Middle colic artery laceration in a 38-year-old man.CT
scan shows a lobulated hyperattenuating area (arrow) that represents extravasation of contrast
material within an otherwise nonopacified hematoma (arrowheads)

16. Distal jejunal perforation & mesenteric
hematoma, in a 51-year-old woman. On a CT scan,subtle collections of intramural air (black
arrow) and intraperitoneal air (white arrows) in the region of the thick-walled jejunum

17. Abdominal CT scan demonstrates an
intraparenchymal liver laceration (white
arrow) and adrenal hematoma (black
arrow), with surrounding retroperitoneal
blood (arrowhead).
periduodenal hematoma thought to be from
the other injuries masks the duodenal
injury (arrows), which could be suspected
on the basis of its ill-defined wall and
adjacent blood
Contusion of the second portion of the
duodenum in a 36-year-old man

18. Abdominal CT scan reveals a thick-
walled and ill-defined duodenum
(straight arrows) and free and
retroperitoneal air (curved arrows),
findings that suggest duodenal injury
air and fluid (open arrows) adjacent to the right
colon. These findings were thought to be
associated with the duodenal injury because
both the duodenum and right colon reside in the
anterior pararenal space. Black arrow indicates
free air. The thick-walled jejunum (solid white
arrow) was normal at surgery
TRANSECTION OF THE SECOND PORTION OF THE DUODENUM AND FULL-
THICKNESS PERFORATION OF THE RIGHT COLON IN A 46-YEAR-OLD WOMAN

19. CT
FINDINGS

20. 1-Free Intraperitoneal Air

21. A

22. B

23. 2-FREE
RETROPERITONEAL
AIR

26. 3-Extraluminal
Oral Contrast
Material

28. 4-Bowel Wall Defect
Direct visualization of a defect in the
bowel wall due to perforation is
rare, but visualization of such a
defect is diagnostic Even with
careful retrospective review

29. 5-Bowel Wall Thickening

30. focal small bowel thickening on the left side (arrows). Note the fluid at the mesenteric
root (M). There is a moderate amount of free fluid (F); the free fluid was predominantly
located within the pelvis. A small jejunal perforation was found at surgery.
Bowel wall thickening in a 4-year-old boy

31. 6-FOCAL
HEMATOMA

32. FOCAL HAEMATOMA

33. FOCAL HAEMATOMA

34. Active hemorrhage

35. Mesenteric
Pseudoaneurysm
Mesenteric pseudoaneurysms are rare.
high likelihood of bowel ischemia or
infarction .
As with pseudoaneurysms within other
abdominal structures, there is a high
likelihood of continued or renewed
hemorrhage.

36. Mesenteric pseudoaneurysm
a large mesenteric tear with right colonic ischemia was found
right side with an enhancing pseudoaneurysm (*) and evidence of active hemorrhage (arrowheads).
large hematoma (H) F = free
intraperitoneal fluid.

37. ABDOMINAL AORTIC INJURY
The spectrum of aortic pathology ranges from intimal disruption to pseudo-
aneurysm formation. Unlike the thoracic aorta, which is screened easily with
chest radiographs, there is no adequate screening examination for the
abdominal aorta.

38. Aortic Injuries: pathology
They are TEARS not dissections, so best terminology
would be: Traumatic Aortic Injury or TAI
The lesion is an aortic wall TEAR, not a dissection.
The tear is through the intima and media, with the thin
but tough adventitia containing the blood volume as a
pseudoaneurysm for a time.
When the adventitia fails, the patient usually immediately
expires

39. ABDOMINAL AORTIC INJURY
CT, CTA and conventional contrast aortography are
the main imaging procedures.

40. Incomplete rupture of the descending aorta in a 51-year-old man with blunt thoracic trauma from a
traffic accident.
CT image (a) (b) show a saccular outpouching of the descending aorta. The outpouching is
demarcated from the aortic lumen by a collar (arrowheads), and there is only a small periaortic
hematoma. The nasogastric tube is not deviated.

41. . CT image of the aortic isthmus shows
complete transection of the aortic wall
(arrowheads) with a periaortic hematoma
and hemomediastinum.
Anteroposterior chest radiograph shows a
widened upper mediastinum with a faint left
apical extrapleural cap (arrows).
Complete aortic rupture in a 48-year-old
woman with blunt thoracic trauma from a
skydiving accident. The lesion was
successfully repaired at surgery; however,
the patient subsequently died due to
severe brain injury

42. your name
Complex aortic dissection and bilateral hemothorax in a 44-year-
old woman with blunt thoracic trauma from a motorcycle accident.
(a) Axial CT image of the aortic arch shows the intimomedial flap,
which divides the aorta into true (T) and false (F) lumin

43. DIAPHRAGMATIC INJURY
Traumatic diaphragmatic hernia can result from either penetrating (e.g., knife and
bullet wounds) or blunt (e.g., motor vehicle accidents, falls, and crushes) injury.
Diaphragmatic rupture is recognized in about 0.5% of blunt trauma survivors in
various series.

44. Traumatic Rupture of the Right Diaphragm
Right diaphragmatic rupture and duodenal contusion in a 43-year-old man. (a)
Abdominal CT scan shows a posterior right rib fracture (arrow) at the site of a
diaphragmatic hematoma (black arrowheads).

45. a CT scan obtained at a lower level, extension of the diaphragmatic hematoma
into the posterior pararenal space
(arrow) was erroneously thought to be the source of the periduodenal
hematoma in the anterior pararenal space.
Subcutaneous air (white arrowheads in a and b) from barotrauma is visible

46. PELVIC HEMATOMA
Hemorrhage associated with pelvic trauma, with
or without pelvic fracture, is common and can
arise from venous, osseous, or arterial sources or
any combination of the above. Typically, pelvic
hemorrhage is treated first using external
fixation, which usually is successful in treating
venous and osseous bleeding through a
tamponade effect.

47. PELVIC HEMATOMA
Continued bleeding may indicate an arterial
source, surgical exploration for such
patients is difficult and complex due to
difficulties in visualization of the
hemorrhagic arteries.
In many centers catheter angiography and
embolization is considered the standard for
diagnosis and treatment for pelvic trauma.
CT is also necessary for diagnosis of the
site of hematoma and associated fractures.

48. THANK YOU