Case 1
40 years old male patient presented to
ER following MCA ,his FAST exam
revealed fluid collection at both
Morrison's pouch & pelvic regions ,so
CT exam of the abdomen & pelvis with
IV contrast was the next step to
identify any organ injury.
CT exam of the abd& pelvis with IV
contrast revealed:
 Stranding &hematoma of the mesentery
 Minimal fluid collection noted at the right
paracolic gutter& pelvic regions
 Bowel loops near the site of mesenteric
stranding are seen slightly distended.
Diagnosis
Mesenteric injury
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This patient was managed conservatively
for one week and he had uneventful
recovery.
CASE 2
23 years old male, presented to ER after
his belly had been squeezed between a
machine and the wall, he had positive
FAST exam for free fluid collection at
Morrison'sPouch, splenorenal& pelvic
regions & so CT exam of the abdomen
and pelvis following IV contrast was the
next step.
CT exam of the abdomen & pelvis following
IV contrast revealed:
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extraluminal free air(multiple small air bubbles)
are noted throughout the whole abdomen.
intramural air is also noted (this with
extraluminal air strongly suggest full thickness
rather than partial thickness injury).
free intrabdominal, pelvic& interloop fluid
collection is also noted.
bowel wall thickening.
bowel wall are also seen enhanced.
Mesenteric stranding is also noted.
Diagnosis
Small Bowel Trauma

At surgery the patient had atear at
the proximal jejunum where the
bowel loops were distended at and
near the site of the tear; resection
anastomosis of the affected bowel loop
was done.
Case 3
15 years old male patient, he was hit by
amotorcycle, the patient had negative
FAST exam at the same day of the
accident and so he was discharged;
 The next day he presented again to ER
with vomitting & abdominal pain .
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US didn't reveal any fluid collection though a
heterogenous mass appeared infront of the right
kidney ,to the right of the pancreas,posterior to
the gallbladder) at the typical site of the second
part of the duodenum.it appears with
hyperechoic periphery &anechoic center) so non
enhanced CT abdomen & pelvis was performed
then CT following oral & iv contrast,that
confirmed the mass which appears
heterogenous also at the CT with enhancing
periphery with internal extensions
Diagnosis
DUODENAL HEMATOMA
Blunt trauma Bowel & Mesenteric
injury
Detection of bowel and mesenteric injury
can be challenging in patients after blunt
abdominal trauma. Early diagnosis and
treatment are critical to decrease patient
morbidity and mortality.
 Computed tomography (CT) has become
the primary modality for the imaging of
these patients .

Hemoperitoneum detected with ultrasonography is
no longer an indication for exploratory laparotomy in
a stable patient. More emphasis is now placed on
nonsurgical management of ,spleen and renal
injuries.
 The concurrent presence of significant bowel or
mesenteric injury, however, would make
conservative treatment inappropriate and
necessitates exploratory laparotomy. Therefore,
greater sensitivity and specificity of imaging studies
are demanded for these types of injury .
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CT findings of bowel trauma:
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Bowel Discontinuity (Definite sign).
Extraluminal Oral Contrast Material
(pathognomonic of bowel injury).
Extraluminal Air
(pathognomonic of bowel injury).
Intramural Air.
Bowel-Wall Thickening.
Bowel-Wall Enhancement .
Intraperitoneal and Retroperitoneal Fluids.
Mesenteric foci of fluid, air, or fat stranding
may be secondary to bowel injury alone
Findings Specific to
Mesenteric Injury
Mesenteric Extravasation (pathgnomonic).
 Mesenteric Vascular Beading.
 Abrupt termination of Mesenteric Vessels.
 Mesenteric Infiltration.
 Mesenteric Hematoma
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NB:
If there is no other explanation for
intraperitoneal fluid,bowel or mesenteric
injury should be considered.
Duodenal Hematoma
A traumatic duodenal hematoma (DH) is an
unusual event, occurring mainly in children and
young individuals, with a male predominance in
both age groups. Furthermore, it can be a
diagnostic challenge because of unreliable
history, nonspecific signs and symptoms,
delayed appearance, and the duodenum’s
retroperitoneal location.
 Sonography is considered a reliable screening
tool for blunt abdominal trauma (BAT(
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Resident.Dalia Ibrahim