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Everything you need to know about Computed Tomography (CT) & CT Scanning

Colon: Trauma Imaging Pearls - Educational Tools | CT Scanning | CT Imaging | CT Scan Protocols - CTisus
Imaging Pearls ❯ Colon ❯ Trauma

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  • However, a colonoscopy is the most common cause of iatrogenic splenic injury (in comparison to other procedures or surgeries). The risk factors for splenic injury are both patient and operator dependent. Patient-dependent factors include pre-existing enlargement of the spleen, surgical adhesions, inflammatory bowel disease, and severe diverticular disease. Operator dependent factors include placing the patient on their back, excessive traction, over sedation, slide by advancement, and applying excessive external pressure. Despite these factors, it is still difficult to discern if the complication is unpredictable or directly related to technical factors given rarity of this complication.
  • Splenic injury is a rare but serious complication of colonoscopy. Since the mid-1970s, 68 splenic injuries during colonoscopy including our 2 cases have been described. With the increasing use of colonoscopy, endoscopists, surgeons, and radiologists are more likely to encounter this unusual complication. Any cause of increased splenocolic adhesions, splenomegaly, or underlying splenic disease might be a predisposing factor for splenic injury during colonoscopy. However, it can occur in patients without significant adhesions or underlying splenic pathology. The diagnosis is often described in the literature as delayed, because many physicians are not aware of this complication of colonoscopy. Although computerized tomography is highly sensitive, knowledge of this complication is the best tool to aid in early diagnosis. Patients with abdominal pain, hypotension, and a drop in hematocrit without rectal bleeding after colonoscopy should be suspected of having splenic injury.
    Splenic injury after elective colonoscopy.
    Sarhan M, Ramcharan A, Ponnapalli S.  
    JSLS. 2009;13(4):616-619.
  • Splenic injury is a rare but serious complication of colonoscopy. Since the mid-1970s, 68 splenic injuries during colonoscopy including our 2 cases have been described. With the increasing use of colonoscopy, endoscopists, surgeons, and radiologists are more likely to encounter this unusual complication. Any cause of increased splenocolic adhesions, splenomegaly, or underlying splenic disease might be a predisposing factor for splenic injury during colonoscopy. However, it can occur in patients without significant adhesions or underlying splenic pathology. The diagnosis is often described in the literature as delayed, because many physicians are not aware of this complication of colonoscopy.  
    Splenic injury after elective colonoscopy.
    Sarhan M, Ramcharan A, Ponnapalli S.  
    JSLS. 2009;13(4):616-619.
  • The diagnosis is often described in the literature as delayed, because many physicians are not aware of this complication of colonoscopy. Although computerized tomography is highly sensitive, knowledge of this complication is the best tool to aid in early diagnosis. Patients with abdominal pain, hypotension, and a drop in hematocrit without rectal bleeding after colonoscopy should be suspected of having splenic injury.
    Splenic injury after elective colonoscopy.
    Sarhan M, Ramcharan A, Ponnapalli S.  
    JSLS. 2009;13(4):616-619.
  • “Bowel and mesenteric injuries are detected in 5% of blunt abdominal trauma patients at laparotomy and are the third most common type of injury from blunt trauma to abdominal organs. Three basic mechanisms may cause bowel and mesenteric injuries of blunt trauma: Direct force may crush the gastrointestinal tract; rapid deceleration may produce shearing force between fixed and mobile portions of the tract; and a sudden increase in intraluminal pressure may result in bursting injuries.”
    Evaluation of Bowel and Mesenteric Trauma with Multidetector CT
    Brofman N et al.
    RadioGraphics July 2008;26: 1119-1131
  • “Computed tomography (CT) has been shown to be accurate for the diagnosis of bowel and mesenteric injuries and is the diagnostic test of choice in the evaluation of blunt abdominal trauma in hemodynamically stable patients. Specific CT findings of bowel and mesenteric injuries include bowel wall defect, intraperitoneal and mesenteric air, intraperitoneal extraluminal contrast material, extravasation of contrast material from mesenteric vessels, and evidence of bowel infarct.”
    Evaluation of Bowel and Mesenteric Trauma with Multidetector CT
    Brofman N et al.
    RadioGraphics July 2008;26: 1119-1131
  • “ The common sites of blunt trauma injury in the small bowel are the proximal jejunum, near the ligament of Treitz, and the distal ileum, near the ileocecal valve. In these regions, mobile and fixed portions of the gut are continuous and therefore are susceptible to shearing force.”
    Evaluation of Bowel and Mesenteric Trauma with Multidetector CT
    Brofman N et al.
    RadioGraphics July 2008;26: 1119-1131
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