Künt barsak yaralanması

Özet

Künt karın travması sonrası ince bağırsak, kolon veya duodenumda kontüzyon, hematom, iskemi ya da tam kat perforasyon gelişebilir. İntravenöz kontrastlı BT stabil hastada duvar bütünlüğünü, kontrastlanmayı, serbest havayı ve komşu mezenteri birlikte değerlendirir; perforasyonun doğrudan işaretleri daha özgül, sıvı ve yağ kirlenmesi gibi işaretler daha dolaylıdır. İzole serbest sıvı veya hafif duvar değişikliği tek başına kesin yaralanma anlamına gelmez, fakat diğer ipuçlarıyla birleştiğinde şüpheyi artırır. İlk BT'de silik kalan duvar yaralanması veya mezenter hasarının gözden kaçırılması, gecikmiş iskemi, perforasyon ve peritoniteye yol açabilir.

Faz ve pencere

Portal tanısal

İnce bağırsak ve kolon duvarında fokal kalınlaşma, intramural hematom, duvar defekti ve anormal ya da azalmış kontrastlanma; mezenterik damar kesintisi ve serbest sıvı portal venöz kontrastlı görüntülerde değerlendirilir.

Kontrastsız

Kontrastsız görüntü varsa intramural kanı, yüksek atenüasyonlu hematomu ve serbest havayı gösterebilir; barsak duvarı perfüzyonu bu fazda değerlendirilemez ve travma değerlendirmesinde kontrastlı portal fazın yerini tutmaz.

Önerilen pencereler: Batın (G 400 / M 50), Yumuşak doku (G 400 / M 40), Akciğer (G 1500 / M -600).

BT bulguları

• Duvar kesintisi — ans duvarının fokal süreklilik kaybı, özellikle komşu ekstraluminal hava veya içerikle birlikte doğrudan perforasyon bulgusudur.
• Ekstraluminal hava — pnömoperitoneum, belirgin toraks yaralanması olmadan travma sonrası görüldüğünde içi boş organ perforasyonunu düşündürür; hava küçük ve mezenterik olabilir.
• Ekstraluminal barsak içeriği veya oral kontrast kaçağı — duvar defektinden peritoneal boşluğa uzanan içerik tam kat yaralanma için güçlü doğrudan işarettir.
• Fokal duvar kalınlaşması veya intramural hematom — kontüzyon ya da duvar içi kanamayı düşündürür; ans lümeninde daralma yapabilir.
• Azalmış duvar kontrastlanması — komşu anslara göre hipoenhansman, mezenter damar hasarına bağlı iskemi olasılığını artırır.
• Solid organ yaralanması olmadan serbest sıvı — özellikle interloop veya mezenterik sıvı ile birlikteyse içi boş organ/mezenter hasarı için dolaylı uyarıdır.
• Mezenterik hematom veya yağ kirlenmesi — komşu ans duvarı kalınlaşması, damar kesintisi veya fokal sıvı odağıyla eşleştiğinde barsak yaralanmasına komşu mezenter hasarını destekler.

Normalde

Normal anslarla kıyaslamada şüpheli segmentte duvar kalınlaşması veya hematomu, mezenterik hematom ya da yağ infiltrasyonunu ve serbest sıvıyı arayın. Şüpheli segmenti karşı anslarla kıyaslayın; duvar kalınlaşması veya hematomu, mezenterik hematom ya da yağ infiltrasyonunu ve serbest sıvıyı birlikte değerlendirin.

Ayırıcı tanı

Enfeksiyöz enterit, ince bağırsak duvar kalınlaşmasının ayırıcı tanısında yer alabilir.

İskemik kolit

duvar hipoenhansmanı ve ödem gösterebilir; vasküler dağılım ve klinik zemin travmatik fokal yırtılmadan farklıdır.

Pankreas-duodenal yaralanma

retroperitoneal yerleşimi nedeniyle klinik bulgular maskeleyebilir ve BT hassasiyetini düşürebilir; yüksek şüpheyle görüntülenmelidir.

Tuzaklar

• Az miktardaki basit sıvıyı tek başına bağırsak perforasyonu olarak değerlendirmeyin; solid organ yaralanmasının yokluğunu, anslar arası sıvı dağılımını ve eşlik eden duvar veya mezenter işaretlerini birlikte değerlendirin.
• Duvar kalınlaşması veya hematomu tek başına kesin yaralanma kabul etmeyin; mezenterik hematom, yağ infiltrasyonu ve serbest sıvı gibi diğer BT bulgularını da değerlendirin.
• Azalmış duvar kontrastlanmasını yalnızca faz farkı sanma; aynı portal fazdaki komşu ansları ve besleyen mezenter damarları kontrol et.
• İlk BT'de ekstraluminal havanın bulunmamasını iskemi veya perforasyon dışlama ölçütü olarak kabul etmeyin; mezenter hasarı sonrası duvar nekrozu ve perforasyon gecikebilir.

Kendini dene

1. Künt karın travması sonrası BT'de barsak duvarı kesintisi ve serbest intraperitoneal hava görülüyor. En olası tanı nedir?

   • İleum perforasyonu
   • Şok barsağı
   • Enfeksiyöz enterit
   • İskemik kolit
   Cevabı göster

   İleum perforasyonu. Fokal duvar kesintisi ve komşu ekstraluminal gaz perforasyonu doğrudan destekler. Duvar kesintisi ve serbest intraperitoneal hava, künt travmada değerlendirilen barsak yaralanması BT bulgularındandır.

2. Künt mezenter yaralanmasında bir ans duvarında azalmış kontrastlanma görülüyor. En önemli olasılık hangisidir?

   • Mezenter kaynaklı iskemi
   • Fizyolojik kollaps
   • Basit asit
   • Kolonik divertikülit
   Cevabı göster

   Mezenter kaynaklı iskemi. Fokal hipoenhansman ile komşu mezenter hematomu damar beslenmesinin bozulmasına bağlı iskemi için uyarıcıdır. Künt mezenter yaralanmasında erken BT'de azalmış barsak duvarı kontrastlanması iskemi için güçlü bir öngördürücüdür.

Bu konunun yer aldığı turlar

• Politravma (tüm gövde) BT'si

İlgili konular

• Mezenter yaralanması
• Duodenal ve retroperitoneal yaralanma
• Hemoperitoneum ve retroperitoneal kanama

Kaynaklar

Bu sayfadaki 36 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 11 cümle bu karşılaştırmada düzeltildi (2026-10-08).

1. Multiple portions enteral nutrition and chyme reinfusion of a blunt bowel injury patient with hyperbilirubinemia undergoing open abdomen: A case reportpmc.ncbi.nlm.nih.gov
2. Outcomes of selective surgery in patients with suspected small bowel injury from blunt traumapmc.ncbi.nlm.nih.gov
3. Jejunal Perforation Associated With a Horseshoe‐Shaped Abdominal Contusion After a Horse Kick: A Case Reportpmc.ncbi.nlm.nih.gov
4. Matters arising: expanding the literature base on blunt trauma-induced abdominal wall herniapmc.ncbi.nlm.nih.gov
5. Delayed Recognition of Multiple Small Bowel Perforations and Mesenteric Lacerations Following Combined Blunt and Penetrating Lumbar Trauma: A Case Reportpmc.ncbi.nlm.nih.gov
6. CT imaging signs of surgically proven bowel trauma.pubmed.ncbi.nlm.nih.gov
7. The Prognosis of Blunt Bowel and Mesenteric Injury-the Pitfall in the Contemporary Image Survey.pubmed.ncbi.nlm.nih.gov
8. Index CT-Based Scoring Systems in Operative Blunt Bowel and Mesenteric Injury Identification.pubmed.ncbi.nlm.nih.gov
9. Early surgical intervention for blunt bowel injury: the Bowel Injury Prediction Score (BIPS).pubmed.ncbi.nlm.nih.gov
10. Core curriculum illustration: blunt trauma to the bowel.pubmed.ncbi.nlm.nih.gov
11. Outcomes of selective surgery in patients with suspected small bowel injury from blunt trauma.pubmed.ncbi.nlm.nih.gov
12. The role of repeat computed tomography scan in the evaluation of blunt bowel injury.pubmed.ncbi.nlm.nih.gov
13. Abdominal computed tomography scoring systems and experienced radiologists in the radiological diagnosis of small bowel and mesenteric injury.pubmed.ncbi.nlm.nih.gov
14. Multi-center validation of the Bowel Injury Predictive Score (BIPS) for the early identification of need to operate in blunt bowel and mesenteric injuries.pubmed.ncbi.nlm.nih.gov
15. Pediatric Abdominal Trauma.pubmed.ncbi.nlm.nih.gov
16. WSES guidelines on blunt and penetrating bowel injury: diagnosis, investigations, and treatment.pubmed.ncbi.nlm.nih.gov
17. CT Findings of Pediatric Handlebar Injuries.pubmed.ncbi.nlm.nih.gov
18. Traumatic abdominal wall injuries-a primer for radiologists.pubmed.ncbi.nlm.nih.gov
19. Complete traumatic transection of the fourth portion of the duodenum after blunt abdominal trauma: a case report.pubmed.ncbi.nlm.nih.gov
20. Expectant management of a pediatric patient with traumatic intussusception: Case report with literature review.pubmed.ncbi.nlm.nih.gov
21. Imaging and clinical features of intra-abdominal injuries in children with suspected physical abuse.pubmed.ncbi.nlm.nih.gov
22. Pneumatosis intestinalis revisited: associated imaging findings, clinical correlation, management, risk stratification and future perspectives.pubmed.ncbi.nlm.nih.gov
23. Understanding Air in the Body: A Radiologic Perspective on Emphysematous and Traumatic Conditions.pubmed.ncbi.nlm.nih.gov
24. Early Sodium Dynamics in Severely Injured Patients with Intestinal Perforations: A Multicenter Analysis.pubmed.ncbi.nlm.nih.gov
25. Volume-dependent detection of free intraperitoneal fluid by FAST: a prospective in-vivo study with sequential fluid instillation.pubmed.ncbi.nlm.nih.gov
26. Clinical assessment versus radiological investigations: Predictive accuracy for intra-abdominal injury after blunt trauma.pubmed.ncbi.nlm.nih.gov
27. Midgut Volvulus Secondary to Intestinal Malrotation in an 11-Year-Old Child With Preserved Bowel Viability: A Rare Delayed Presentation.pubmed.ncbi.nlm.nih.gov
28. An atypical presentation of mesenteric bucket-handle injury following direct trauma during football: a case report.pubmed.ncbi.nlm.nih.gov
29. Relative colon wall attenuation - distinguishing ischemia from other colon wall changes.pubmed.ncbi.nlm.nih.gov
30. Computed tomography of pediatric abdominal trauma: optimizing utilization and enhancing diagnostic interpretation.pubmed.ncbi.nlm.nih.gov
31. The Many Faces of the Angry Peritoneum.pubmed.ncbi.nlm.nih.gov
32. Diagnostic Role of Multi-Detector Computed Tomography in Acute Mesenteric Ischemia.pubmed.ncbi.nlm.nih.gov
33. Advances in Imaging and Diagnosis of Emphysematous Cholecystitis.pubmed.ncbi.nlm.nih.gov
34. Integrating CT radiomics and morphologic features for preoperative risk stratification of gastrointestinal stromal tumours.pubmed.ncbi.nlm.nih.gov
35. Complications after Nephron-sparing Interventions for Renal Tumors: Imaging Findings and Management.pubmed.ncbi.nlm.nih.gov
36. Appendiceal abscess: pathologic definitions and a diagnostic framework-SIRC/SICUT consensus.pubmed.ncbi.nlm.nih.gov
37. Surgical management of duodenal perforation complicated with retroperitoneal abscesses and paralytic ileus: a case report.pubmed.ncbi.nlm.nih.gov
38. Delayed Recognition of Multiple Small Bowel Perforations and Mesenteric Lacerations Following Combined Blunt and Penetrating Lumbar Trauma: A Case Report.pubmed.ncbi.nlm.nih.gov
39. Delayed Colonic Perforation Following Blunt Abdominal Trauma: A Diagnostic Dilemma.pubmed.ncbi.nlm.nih.gov
40. [Detection and emergency management of visceral injuries after abdominal trauma : Hollow organ and mesenteric injuries-keep in mind].pubmed.ncbi.nlm.nih.gov
41. Prevention, Recognition, and Management of Anastomotic Leakage and Pelvic Sepsis After Rectal Cancer Surgery: A Structured Narrative Review.pubmed.ncbi.nlm.nih.gov
42. Prevention and Management of Endoscopic Retrograde Cholangiopancreatography-Related Perforation: A Guideline-Based Narrative Review.pubmed.ncbi.nlm.nih.gov
43. Duodenal Trauma: Mechanisms of Injury, Diagnosis, and Management.pubmed.ncbi.nlm.nih.gov
44. Spontaneous intramural small-bowel hematoma secondary to coagulopathy in patients receiving vitamin K antagonists: A case series report.pubmed.ncbi.nlm.nih.gov
45. Blocked by a clot: subserosal cecal hematoma causing bowel obstruction - a case report.pubmed.ncbi.nlm.nih.gov
46. Spontaneous intramural hematoma of the small bowel in anticoagulated patients-Insights into management: A case report.pubmed.ncbi.nlm.nih.gov
47. Non-occlusive mesenteric ischemia secondary to diabetic ketoacidosis in a patient receiving olanzapine: A case report.pubmed.ncbi.nlm.nih.gov
48. CT-based radiological score (AMESI CT-score) for severity of bowel injury in acute mesenteric ischemia.pubmed.ncbi.nlm.nih.gov
49. Role of magnetic resonance in bowel pathologies: Beyond inflammatory bowel disease.pubmed.ncbi.nlm.nih.gov
50. Critical appraisal and temporal validation of the Niguarda scoring model: a CT-based diagnostic score for detecting hollow viscus and mesenteric injury in blunt abdominal trauma.pubmed.ncbi.nlm.nih.gov
51. A literature review and case report: Traumatic appendicitis in an elderly patient with spinal cord injury and medical comorbidities.pubmed.ncbi.nlm.nih.gov
52. Occult Small Bowel Injury With Delayed Retroperitoneal Abscess Formation After Blunt Trauma: A Case Report.pubmed.ncbi.nlm.nih.gov
53. Predictive Value of Preoperative CT Findings for Bowel Ischemia in Patients with Blunt Mesenteric Injury: A Retrospective Cohort Study.pubmed.ncbi.nlm.nih.gov
54. Feasibility and diagnostic validity of abdominal aortic aneurysm screening in Hungarian primary care: a multiregional pilot study.pubmed.ncbi.nlm.nih.gov
55. Reliability of CT Enterography for Describing Fibrostenosing Crohn Disease.pubmed.ncbi.nlm.nih.gov
56. Experimental study and clinical significance of the impact of gastrointestinal motility disorders on hepatic blood perfusion.pubmed.ncbi.nlm.nih.gov
57. Acute and chronic complications of cesarean delivery: An update for the general radiologist.pubmed.ncbi.nlm.nih.gov
58. Ultrasound-based nomogram for predicting high-risk hepatic portal venous gas in children: a retrospective cohort study.pubmed.ncbi.nlm.nih.gov
59. Clinical and Imaging Characteristics to Discriminate Between Complicated and Uncomplicated Acute Cholecystitis: A Regression Model and Decision Tree Analysis.pubmed.ncbi.nlm.nih.gov
60. Percutaneous transesophageal gastric catheter removal and follow up: A case series.pubmed.ncbi.nlm.nih.gov
61. LOOPS for thought: identifying gastrointestinal pathology on transthoracic echocardiography.pubmed.ncbi.nlm.nih.gov
62. Mechanical Small Bowel Obstruction Secondary to Low-Grade Appendiceal Mucinous Neoplasm: A Case Report.pubmed.ncbi.nlm.nih.gov
63. A Rare Presentation of Cecal Adenocarcinoma Causing Adult Ileocolic Intussusception: A Case Report.pubmed.ncbi.nlm.nih.gov
64. Expected Values of Artificial Intelligence in Colon Capsule Endoscopy: Artificial Intelligence in Capsule Endoscopy Consortium Position Statement.pubmed.ncbi.nlm.nih.gov
65. Gastrointestinal Ultrasound: Measurements and Normal Findings - What Do You Need to Know?pubmed.ncbi.nlm.nih.gov
66. Human biomarker navigator.pubmed.ncbi.nlm.nih.gov
67. Imaging of Acute Abdominopelvic Pain in Pregnancy and Puerperium-Part II: Non-Obstetric Complications.pubmed.ncbi.nlm.nih.gov
68. Assessing Pancreatic Enhancement Variability in ICU Patients with CT Hypoperfusion Complex: A Retrospective Single-Center Study.pubmed.ncbi.nlm.nih.gov
69. Adult Hepatic Infarction for Internists: A Practical Diagnostic and Management Pathway to Avoid Misdiagnosis, Unnecessary Drainage, and Delayed Vascular Recognition.pubmed.ncbi.nlm.nih.gov
70. High-Velocity Drag Racing Collision Leading to Rare Superior Mesenteric Branch Injury: A Case Report.pubmed.ncbi.nlm.nih.gov
71. Stricturing Diseases of the Gastrointestinal Tract-Current Clinical Practice.pubmed.ncbi.nlm.nih.gov
72. Gastrointestinal complications in intensive care.pubmed.ncbi.nlm.nih.gov
73. Radiomitigators: Breakthroughs in Post-Radiation Recovery.pubmed.ncbi.nlm.nih.gov
74. When It Is Not NEC: Recognizing Mimics of Necrotizing Enterocolitis in Preterm Infants.pubmed.ncbi.nlm.nih.gov
75. Fetal MRI: abdominal cystic lesions.pubmed.ncbi.nlm.nih.gov
76. Eosinophilic Duodenitis and Jejunitis with Ascites and Peripheral Eosinophilia: A Diagnostic Challenge-Case Report.pubmed.ncbi.nlm.nih.gov
77. Strangulated Small Bowel Obstruction Caused by a Migrated Ring-Shaped Intrauterine Device: Two Case Reports and a Literature Review.pubmed.ncbi.nlm.nih.gov
78. Imaging of Strictures in Crohn's Disease.pubmed.ncbi.nlm.nih.gov
79. Gastrointestinal Ultrasound in Emergency Setting.pubmed.ncbi.nlm.nih.gov
80. Hepatic portal venous gas in severe neurocritical illness after intracranial surgery: Two case reports and literature review.pubmed.ncbi.nlm.nih.gov
81. Spectral Computed Tomography Angiography in Visceral Artery Aneurysms: Technical Principles and Clinical Applications.pubmed.ncbi.nlm.nih.gov
82. Dual-energy computed tomography in children: Technique and clinical applications.pubmed.ncbi.nlm.nih.gov
83. Current Evidence on the Management of Non-occlusive Mesenteric Ischemia: A Comprehensive Narrative Review.pubmed.ncbi.nlm.nih.gov
84. Laparoscopic resection of a small intestinal venous malformation presenting as acute bowel obstruction without hemorrhage in a child: a case report.pubmed.ncbi.nlm.nih.gov
85. The Great Mimicker: Extragonadal Endometriosis Presenting as an Appendiceal Mass and Acute Appendicitis.pubmed.ncbi.nlm.nih.gov
86. Clinical, Radiological, and Surgical Risk Factors for Endoscopic Anastomotic Recurrence Following Surgery in Crohn's Disease.pubmed.ncbi.nlm.nih.gov
87. Small bowel perforation secondary to swallowed denture impaction at an NSAID-induced ileal diaphragm.pubmed.ncbi.nlm.nih.gov
88. A Rare Adult Ileal Intussusception Caused by Perineurioma.pubmed.ncbi.nlm.nih.gov
89. Case Report: Acute superior mesenteric vein and portal vein thrombosis complicated by small intestinal necrosis: a case of successful endovascular treatment.pubmed.ncbi.nlm.nih.gov
90. Case Report: Progressive acquired ileal mesenteric venous malformation after right hemicolectomy: serial imaging evolution leading to delayed gastrointestinal bleeding.pubmed.ncbi.nlm.nih.gov
91. Case Report: Two rare cases of aggressive fibromatosis originating in the intestinal tract.pubmed.ncbi.nlm.nih.gov
92. Complications and expected imaging findings after endoscopic retrograde cholangiopancreatography.pubmed.ncbi.nlm.nih.gov
93. Postoperative Pulmonary Complications: Clinical and Imaging Insightspubmed.ncbi.nlm.nih.gov
94. Radiological insights into diverticulitis: Clinical manifestations, complications, and differential diagnosis.pubmed.ncbi.nlm.nih.gov
95. Non-occlusive mesenteric ischemia complicated by ischemic hepatitis presenting as severe lactic acidosis: a case report.pubmed.ncbi.nlm.nih.gov
96. Severe celiac trunk stenosis following blunt trauma in a patient with diabetic ketoacidosis: a diagnostic dilemma of traumatic injury versus median arcuate ligament syndrome.pubmed.ncbi.nlm.nih.gov
97. Rescue Veno-Venous Extracorporeal Membrane Oxygenation for Aspiration-Induced Refractory Hypoxaemia Before Non-Deferrable Abdominal Surgery: A Case Report.pubmed.ncbi.nlm.nih.gov
98. Spontaneous mesenteric hemorrhage following a sneezing episode associated with an intestinal pseudodiverticulum: a case report.pubmed.ncbi.nlm.nih.gov
99. Case Report: Bezoar-mimicking intraluminal gossypiboma causing small-bowel obstruction and chronic malabsorption 15 years after hysterectomy.pubmed.ncbi.nlm.nih.gov
100. Jejunal Perforation Associated With a Horseshoe-Shaped Abdominal Contusion After a Horse Kick: A Case Report.pubmed.ncbi.nlm.nih.gov
101. Mesenteric Hematoma as a Warning Sign for Missed Bowel Injury.pubmed.ncbi.nlm.nih.gov
102. Intestinal Ultrasound in Inflammatory Bowel Disease: Monitoring Inflammation and Treatment Response.pubmed.ncbi.nlm.nih.gov
103. Beyond Description: A Functional GIUS-Based Algorithm for Enteral Feeding Decisions in the ICU.pubmed.ncbi.nlm.nih.gov
104. Usefulness of ultrasound in diagnosing constipation in children: a narrative review.pubmed.ncbi.nlm.nih.gov
105. Lupus Enteritis Presenting as Acute Abdomen with Clear Gelatinous Stools in a Woman with Systemic Lupus Erythematosus: A Case Report and Literature Review.pubmed.ncbi.nlm.nih.gov
106. Parasitic leiomyoma of the small bowel mesentery mimicking a gastrointestinal stromal tumor: a case report.pubmed.ncbi.nlm.nih.gov
107. Splenoses and Other Ectopic and Heterotopic Splenic Tissue: The Use of Long-Lasting Enhancement in Contrast-Enhanced Ultrasound to Avoid Unnecessary Intervention.pubmed.ncbi.nlm.nih.gov
108. Synchronous Ileal Metastasis from Pancreatic Ductal Adenocarcinoma: Case Report and Narrative Review with Practical Diagnostic and Management Points.pubmed.ncbi.nlm.nih.gov
109. Relationship Between Sigmoid Volvulus Subtypes, Clinical Course, and Imaging Findings.pubmed.ncbi.nlm.nih.gov
110. Imaging in Acute Abdominal Emergencies: A Narrative Review of Surgical Decision-Making and Outcomes.pubmed.ncbi.nlm.nih.gov
111. Radiologic Imaging of Traumatic Bowel and Mesenteric Injuries: A Comprehensive Up-to-Date Review.pubmed.ncbi.nlm.nih.gov
112. Clinical and CT features of patients with pneumatosis intestinalis: A retrospective single-center study.pubmed.ncbi.nlm.nih.gov
113. Computed Tomographic Findings and Clinical Manifestations of Acute Severe Hypersensitivity to a Non-Ionic Iodinated Contrast Agent in a Castrated Male Dog: A Case Report.pubmed.ncbi.nlm.nih.gov
114. Small Bowel Stricture in a Crohn's Patient: An Unrelated Etiology.pubmed.ncbi.nlm.nih.gov
115. Gastrointestinal Fistulas-What Gastroenterologists Need to Know in 2025.pubmed.ncbi.nlm.nih.gov

Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez. İçerik yapay zekâ destekli bir süreçle güncel literatüre göre cümle cümle kaynaklarla karşılaştırıldı, ancak uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.