Case 1Case 140 years old male patient 40 years old male patient presented to ER following MCA ,his presented to ER following MCA ,his FAST exam revealed fluid FAST exam revealed fluid collection at both Morrison's collection at both Morrison's pouch & pelvic regions ,so CT pouch & pelvic regions ,so CT exam of the abdomen & pelvis exam of the abdomen & pelvis with IV contrast was the next step with IV contrast was the next step to identify any organ injury.to identify any organ injury.

CT exam of the abd& pelvis with IV CT exam of the abd& pelvis with IV contrast revealed:contrast revealed:

Stranding &hematoma of the Stranding &hematoma of the mesentery mesentery

Minimal fluid collection noted at the Minimal fluid collection noted at the right paracolic gutter& pelvic regionsright paracolic gutter& pelvic regions

Bowel loops near the site of Bowel loops near the site of mesenteric stranding are seen slightly mesenteric stranding are seen slightly distended.distended.

DiagnosisDiagnosis

Mesenteric injury Mesenteric injury

This patient was managed This patient was managed conservatively for one week and he conservatively for one week and he had uneventful recovery.had uneventful recovery.

CASE 2CASE 223 years old male, presented to ER  23 years old male, presented to ER  after his belly had been squeezed after his belly had been squeezed between a machine and the wall, he between a machine and the wall, he had positive FAST exam for free fluid had positive FAST exam for free fluid collection at Morrison'sPouch, collection at Morrison'sPouch, splenorenal& pelvic regions & so CT splenorenal& pelvic regions & so CT exam of the abdomen and pelvis exam of the abdomen and pelvis following IV contrast was the next following IV contrast was the next step.step.

CT exam of the abdomen & pelvis CT exam of the abdomen & pelvis following IV contrast revealed:following IV contrast revealed:

extraluminal free air(multiple small air extraluminal free air(multiple small air bubbles) are noted throughout the whole bubbles) are noted throughout the whole abdomen.abdomen.

intramural air is also noted (this with intramural air is also noted (this with extraluminal air strongly suggest full extraluminal air strongly suggest full thickness rather than partial thickness injury).thickness rather than partial thickness injury).

free intrabdominal, pelvic& interloop fluid free intrabdominal, pelvic& interloop fluid collection is also noted.collection is also noted.

bowel wall thickening.bowel wall thickening. bowel wall are also seen enhanced.bowel wall are also seen enhanced. Mesenteric stranding is also noted.Mesenteric stranding is also noted.

DiagnosisDiagnosis

Small Bowel Trauma Small Bowel Trauma

At surgery the patient had atear At surgery the patient had atear at the proximal jejunum where at the proximal jejunum where the bowel loops were distended the bowel loops were distended at and near the site of the teaat and near the site of the tear; r; resection anastomosis of the resection anastomosis of the affected bowel loop was done.affected bowel loop was done.

Case 3Case 3

15 years old male patient, he was hit 15 years old male patient, he was hit by amotorcycle, the patient had by amotorcycle, the patient had negative FAST exam at the same day negative FAST exam at the same day of the accident and so he was of the accident and so he was discharged;discharged;

The next day he presented again to The next day he presented again to ER with vomitting & abdominal pain .ER with vomitting & abdominal pain .

US didn't reveal any fluid collection though a US didn't reveal any fluid collection though a heterogenous mass appeared infront of the heterogenous mass appeared infront of the right kidney ,to the right of the right kidney ,to the right of the pancreas,posterior to the gallbladderpancreas,posterior to the gallbladder)) at the at the typical site of the second part of the typical site of the second part of the duodenum.it appears with hyperechoic duodenum.it appears with hyperechoic periphery &anechoic center) so non periphery &anechoic center) so non enhanced CT abdomen & pelvis was enhanced CT abdomen & pelvis was performed then CT following oral & iv performed then CT following oral & iv contrast,that confirmed  the mass  which contrast,that confirmed  the mass  which appears heterogenous also at the CT with appears heterogenous also at the CT with enhancing periphery with internal extensions enhancing periphery with internal extensions

DiagnosisDiagnosis DUODENAL HEMATOMA DUODENAL HEMATOMA

Blunt trauma Bowel & Blunt trauma Bowel & Mesenteric injuryMesenteric injury

Detection of bowel and mesenteric Detection of bowel and mesenteric injury can be challenging in patients injury can be challenging in patients after blunt abdominal trauma. Early after blunt abdominal trauma. Early diagnosis and treatment are critical to diagnosis and treatment are critical to decrease patient morbidity and decrease patient morbidity and mortality. mortality.

Computed tomography (CT) has Computed tomography (CT) has become the primary modality for the become the primary modality for the imaging of these patients .imaging of these patients .

Hemoperitoneum detected with Hemoperitoneum detected with ultrasonography is no longer an indication for ultrasonography is no longer an indication for exploratory laparotomy in a stable patient. exploratory laparotomy in a stable patient. More emphasis is now placed on nonsurgical More emphasis is now placed on nonsurgical management of ,spleen and renal injuries.management of ,spleen and renal injuries.

The concurrent presence of significant bowel The concurrent presence of significant bowel or mesenteric injury, or mesenteric injury, howeverhowever, would make , would make conservative treatment inappropriate and conservative treatment inappropriate and necessitates exploratory laparotomy. necessitates exploratory laparotomy. Therefore, greater sensitivity and specificity of Therefore, greater sensitivity and specificity of imaging studies are demanded for these types imaging studies are demanded for these types of injury .of injury .

CT findings of bowel trauma: CT findings of bowel trauma: Bowel Discontinuity (Bowel Discontinuity (Definite signDefinite sign).). Extraluminal Oral Contrast Material Extraluminal Oral Contrast Material

((pathognomonic of bowel injurypathognomonic of bowel injury).). Extraluminal Air Extraluminal Air ((pathognomonic of bowel injurypathognomonic of bowel injury).). Intramural Air.Intramural Air. Bowel-Wall Thickening.Bowel-Wall Thickening. Bowel-Wall Enhancement .Bowel-Wall Enhancement . Intraperitoneal and Retroperitoneal Fluids.Intraperitoneal and Retroperitoneal Fluids. Mesenteric foci of fluid, air, or fat Mesenteric foci of fluid, air, or fat

stranding may be secondary to bowel stranding may be secondary to bowel injury aloneinjury alone

Findings Specific to Findings Specific to Mesenteric InjuryMesenteric Injury

Mesenteric Extravasation Mesenteric Extravasation ((pathgnomonicpathgnomonic).).

Mesenteric Vascular Beading.Mesenteric Vascular Beading.Abrupt termination of Mesenteric Abrupt termination of Mesenteric

Vessels.Vessels.Mesenteric Infiltration.Mesenteric Infiltration.Mesenteric HematomaMesenteric Hematoma

NB: NB: If there is no other explanation for If there is no other explanation for

intraperitoneal fluid,bowel or intraperitoneal fluid,bowel or mesenteric injury should be mesenteric injury should be considered.considered.

A traumatic duodenal hematoma (DH) is an A traumatic duodenal hematoma (DH) is an unusual event, occurring mainly in children unusual event, occurring mainly in children and young individuals, with a male and young individuals, with a male predominance in both age groups. predominance in both age groups. Furthermore, it can be a diagnostic Furthermore, it can be a diagnostic challenge because of unreliable history, challenge because of unreliable history, nonspecific signs and symptoms, delayed nonspecific signs and symptoms, delayed appearance, and the duodenum’s appearance, and the duodenum’s retroperitoneal location.retroperitoneal location.

Sonography is considered a reliable Sonography is considered a reliable screening tool for blunt abdominal trauma screening tool for blunt abdominal trauma (BAT(BAT((

Duodenal HematomaDuodenal Hematoma

Resident.Dalia IbrahimResident.Dalia Ibrahim