Physical Address
304 North Cardinal St.
Dorchester Center, MA 02124
Colorectal Trauma
KEY FACTS
Terminology
-
Blunt or penetrating injury to rectum or colon
Imaging
-
Transverse and descending colon are most common sites for blunt traumatic injury
-
Rectum is most common site for penetrating injury
-
-
Best diagnostic clue
-
Colonic wall thickening with adjacent mesenteric hemorrhage or ectopic gas
-
-
Best imaging tool: CECT with multiplanar reformations
-
Rectal and intravenous contrast for penetrating injuries
-
-
CT signs
-
Discontinuity or thickening of colonic wall
-
Extracolonic gas (intra- or retroperitoneal), pericolonic fluid or feces
-
Extravasated blood is nearly isodense to opacified blood vessels
-
Extravasated endoluminal contrast medium = perforation of colon
-
Top Differential Diagnoses
-
Pneumoperitoneum from other causes
-
Nontraumatic bowel wall thickening
Pathology
-
Associated abnormalities
-
Injuries of small intestine, mesentery, solid viscera
-
Pelvic fractures or vertebral (Chance) fractures
-
Clinical Issues
-
Other signs/symptoms
-
Abdominal wall or perineal hematomas
-
Diagnostic Checklist
-
Look for extravasation of vascular and endoluminal contrast media
-
Look for ectopic gas with wide windows on CT
Axial CECT in a 57-year-old man injured in a high-speed motor vehicle accident shows multiple segments of thick-walled small intestine
with infiltration of the adjacent mesentery. Higher-than-water-density fluid
is present within the mesentery and peritoneal recesses.
with infiltration of the adjacent mesentery. Higher-than-water-density fluid is present within the mesentery and peritoneal recesses.
Axial CECT in the same patient shows more small bowel wall thickening
, free intraperitoneal gas
, and active bleeding
from the descending colon.
, free intraperitoneal gas , and active bleeding from the descending colon.
Axial CECT in the same patient shows more bubbles of free air
, sentinel clot, and active bleeding
adjacent to the descending colon
. Also note the vertebral (Chance) fracture
. At surgery, there were several lacerations of small bowel, and the descending colon had a "degloving" injury with active bleeding.
, sentinel clot, and active bleeding adjacent to the descending colon . Also note the vertebral (Chance) fracture . At surgery, there were several lacerations of small bowel, and the descending colon had a "degloving" injury with active bleeding.
Axial CECT in the same patient shows free air
, bowel wall thickening
, mesenteric infiltration, and a seat-belt contusion of the abdominal wall
.
, bowel wall thickening , mesenteric infiltration, and a seat-belt contusion of the abdominal wall .
TERMINOLOGY
Definitions
-
Blunt or penetrating injury to rectum or colon
You're Reading a Preview
Become a Clinical Tree membership for Full access and enjoy Unlimited articles
If you are a member. Log in here
