Free fluid on CT, acceptable indicator for surgery in traumatic bowel mesenteric injury: Study

Taiwan: Free peritoneal fluid (FF) on computed tomography (CT) is modestly sensitive and specific for surgically important traumatic bowel mesenteric injury (TBMI), suggests a recent study. The study was published in the journal Diagnostics on 2 November 2021. 

"Our results provide the most robust evidence to date that after blunt abdominal trauma FF is not the absolute but an acceptable indicator for surgically important TBMI," wrote the authors. "However, still there is a need for randomized controlled trials to confirm these results."

TBMI, an uncommon but high-risk form of blunt abdominal injury, is a challenge in trauma care. After blunt trauma, bowel and mesenteric injuries are infrequent, reported among 5% of abdominal trauma, but they are nevertheless dangerous. TBMI can result in significant blood loss from disrupted mesenteric vessels immediately and remotely from injury time.

The presence of FF in CT is considered the indication for surgical intervention. However, conservative treatment should be applied for minor injuries. Szu-An Chen, Chang Gung University, Taoyuan, Taiwan, and colleagues conducted a systematic review to analyze how reliable the FF is to assess the TBMI. 

For this purpose, the researchers retrieved publications by structured searching among databases, reviewing articles, and major textbooks. Using hierarchical models, summary receiver operating characteristic curves (SROCs) were computed for statistical analysis. 

A total of 14 studies enrolling 4336 patients were eligible for final qualitative analysis. 

The researchers found that the summary sensitivity of FF to predict surgical TBMI was 0.793, and the summary specificity of FF to predict surgical TBMI was 0.733. The diagnostic odds ratio was 10.531. 

"This systematic review summarizes the studies' results presenting the incidence and predicting ability of the free fluid in diagnosing surgically important TBMI," the authors stated.

Reference:

Chen, S.-A.; Wang, C.-Y.; Hsu, C.-P.; Lin, J.-Y.; Cheng, C.-T.; Ouyang, C.-H.; Huang, J.-F.; Liao, C.-H. The Current Diagnostic Accuracy on Free Peritoneal Fluid in Computed Tomography to Determinate the Necessity of Surgery in Blunt Bowel and Mesenteric Trauma—Systemic Review and Meta-Analysis. Diagnostics 2021, 11, 2028. https://doi.org/10.3390/diagnostics11112028