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    Traumatic hollow viscus and mesenteric injury: role of CT and potential diagnostic-therapeutic algorithm

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    Author
    Bonomi, A.M.
    Granieri, S.
    Gupta, S.
    Altomare, M.
    Cioffi, S.P.B.
    Sammartano, F.
    Cimbanassi, S.
    Chiara, O.
    Date
    2020-12-19
    Journal
    Updates in Surgery
    Publisher
    Springer Science and Business Media Deutschland GmbH
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1007/s13304-020-00929-w
    Abstract
    Despite its rarity, traumatic hollow viscus and mesenteric injury (HVMI) have high mortality and complication rates. There is no consensus regarding its best management. Our aim is to evaluate contrast enhanced CT (ceCT) in the screening of HVMI and its capability to assess the need for surgery. All trauma patients admitted to an urban Level 1 trauma center between 2010 and 2018 were retrospectively evaluated. Patients with ceCT scan prior to laparotomy were included. Patients requiring surgical repair of HVMI and a ceCT scan consistent with HVMI were considered true positives. Six ceCT scan criteria for HVMI were used; at least one criterion was considered positive for HVMI. Sensitivity (Sn), specificity (Sp), predictive values (PV), likelihood ratios (LR) and accuracy (Ac) of ceCT of single ceCT criteria and of the association of ceCT criteria were calculated using intraoperative findings as gold standard. Therapeutic time (TT), death probability (DP), and observed mortality (OM) were described. 114 of 4369 patients were selected for ceCT accuracy analysis; 47 were considered true positives. Sn of ceCT for HVMI was 97.9%, Sp 63.6%, PPV 66.2%, NPV 97.6%, + LR 2.69, −LR 0.03, Ac 78%; no single criterion stood out. The association of four or more criteria improved ceCT Sp to 98.5%, PPV to 95.6%, + LR to 30.5. Median TT was 2 h (IQR: 1–3 h). OM was 7.8%—not significantly higher than overall OM. CeCT in trauma has become a reliable screening test for HVMI and a valid exam to select HVMI patients for surgical exploration. Copyright 2020, The Author(s).
    Keyword
    Blunt trauma
    CT scan
    Hollow viscus
    Penetrating trauma
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/14601
    ae974a485f413a2113503eed53cd6c53
    10.1007/s13304-020-00929-w
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