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European Radiology

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01-11-2019 | Laparotomy | Computed Tomography

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

Authors: F. Lannes, U. Scemama, A. Maignan, L. Boyer, L. Beyer-Berjot, S. V. Berdah, K. Chaumoître, M. Leone, T. Bège

Published in: European Radiology | Issue 11/2019

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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Title: Value of early repeated abdominal CT in selective non-operative management for blunt bowel and mesenteric injury
Authors: F. Lannes
U. Scemama
A. Maignan
L. Boyer
L. Beyer-Berjot
S. V. Berdah
K. Chaumoître
M. Leone
T. Bège
Publication date: 01-11-2019
Publisher: Springer Berlin Heidelberg
Keywords: Laparotomy
Laparotomy
Published in: European Radiology / Issue 11/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-019-06212-w

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

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

Abstract

Objectives

Methods

Results

Conclusion

Key Points

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Key Points

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