EURORAD ESR

Case 15295

Mesenteric Shearing Injury

Author(s)
McQuade C 1, O'Brien C 2, O'Neill M 3, Waters PS 1, Buckley O 2, Torreggiani W 2

1: Dept. of Colorectal & General Surgery, The Adelaide & Meath Hospital, Tallaght, Dublin 24, Ireland
2: Dept. of Radiology, The Adelaide & Meath Hospital, Tallaght, Dublin 24, Ireland
3: Dept. of General Surgery, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
 
Patient
male, 37 year(s)
 
 
  • Figure 1
    CT thorax & abdomen coronal portal venous phase

    Soft tissue windows. Large volume intra-abdominal fluid & free air. Multiple locules of subdiaphragmatic free air in the left upper quadrant. Intramural gas involving the proximal jejunum with associated...

     
    Area of Interest: Abdomen; Small bowel; Trauma; Imaging Technique: CT; Procedure: Education; Special Focus: Acute; Ischaemia / Infarction; Trauma;
     
     
  • Figure 2
    CT thorax & abdomen coronal arterial phase

    Soft tissue windows. Large volume of intra-abdominal fluid & free air. Bilateral adrenal gland hyper-enhancement. Jejunal wall thickening and hypoenhancement (yellow arrows). The oesophagus is fluid filled.

     
    Area of Interest: Abdomen; Small bowel; Trauma; Imaging Technique: CT; Procedure: Education; Special Focus: Acute; Ischaemia / Infarction; Trauma;
     
     
  • Figure 3
    CT abdomen axial portal venous phase

    Soft tissue windows. Significant intra-abdominal ascites and pneumoperitoneum. Bilateral adrenal hyperenhancement, consistent with shock. Multiple locules of intramural gas involving the proximal jejunum consistent...

     
    Area of Interest: Abdomen; Small bowel; Trauma; Imaging Technique: CT; Procedure: Education; Special Focus: Acute; Ischaemia / Infarction; Trauma;
     
     
  • Figure 4
    CT abdomen axial

    Axial post contrast CT abdomen on soft tissue windows. Significant intra-abdominal ascites and pneumoperitoneum. There is intra-hepatic portal venous air (yellow arrows).

     
    Area of Interest: Abdomen; Small bowel; Trauma; Imaging Technique: CT; Procedure: Education; Special Focus: Acute; Ischaemia / Infarction; Trauma;
     
     
  • Figure 5
    CT abdomen axial portal venous phase

    Soft tissue windows. Large volume intra-abdominal fluid & free air, with air-fluid level visible. Adrenal gland hyperenhancement, consistent with shock. The IVC has a slit-like appearance.

     
    Area of Interest: Abdomen; Small bowel; Trauma; Imaging Technique: CT; Procedure: Education; Special Focus: Acute; Ischaemia / Infarction; Trauma;
     
     
  • Figure 6
    CT abdomen axial post contrast soft tissue windows

    Large volume intra-abdominal fluid & free air. At the level of the renal arteries, the AP diameter of the IVC is 15mm. Literature suggests a 9mm cutoff in identifying a flattened IVC in shock [6].

     
    Area of Interest: Abdomen; Small bowel; Trauma; Imaging Technique: CT; Procedure: Education; Special Focus: Acute; Ischaemia / Infarction; Trauma;
     
     
  • Figure 7
    CT abdomen axial portal venous phase

    Soft tissue windows. Large volume of anti-dependent free air with associated upper abdominal ascites. Retroperitoneal locules of free air consistent with a perforation (yellow arrow).

     
    Area of Interest: Abdomen; Small bowel; Trauma; Imaging Technique: CT; Procedure: Education; Special Focus: Acute; Ischaemia / Infarction; Trauma;
     
     
Soft tissue windows. Large volume intra-abdominal fluid & free air. Multiple locules of subdiaphragmatic free air in the left upper quadrant. Intramural gas involving the proximal jejunum with associated hypoenhancement of the jejunal wall (yellow arrow).
 
Soft tissue windows. Large volume of intra-abdominal fluid & free air. Bilateral adrenal gland hyper-enhancement. Jejunal wall thickening and hypoenhancement (yellow arrows). The oesophagus is fluid filled.
 
Soft tissue windows. Significant intra-abdominal ascites and pneumoperitoneum. Bilateral adrenal hyperenhancement, consistent with shock. Multiple locules of intramural gas involving the proximal jejunum consistent with ischaemia.
 
Axial post contrast CT abdomen on soft tissue windows. Significant intra-abdominal ascites and pneumoperitoneum. There is intra-hepatic portal venous air (yellow arrows).
 
Soft tissue windows. Large volume intra-abdominal fluid & free air, with air-fluid level visible. Adrenal gland hyperenhancement, consistent with shock. The IVC has a slit-like appearance.
 
Large volume intra-abdominal fluid & free air. At the level of the renal arteries, the AP diameter of the IVC is 15mm. Literature suggests a 9mm cutoff in identifying a flattened IVC in shock [6].
 
Soft tissue windows. Large volume of anti-dependent free air with associated upper abdominal ascites. Retroperitoneal locules of free air consistent with a perforation (yellow arrow).
 
 
 
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