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Single-Contrast CT Sufficient to Detect Bowel Injuries

By MedImaging International staff writers
Posted on 07 Mar 2018

Image: A CT image of an abdominal gunshot wound (Photo courtesy of Ctisus.com).

A new study shows that single-contrast computerized tomography (CT) can spot penetrating abdominopelvic trauma with accuracy comparable with that of triple-contrast CT.

Researchers at Barnes‐Jewish Hospital (St. Louis, MO, USA) and Washington University in St. Louis (WUSTL; MO, USA) conducted a retrospective study involving 274 patients (median age 27 years old) who presented at the emergency department (ED) with penetrating abdominopelvic trauma, of which 77% sustained gunshot wounds (GSWs). All patients underwent an abdominopelvic CT using a single intravenous (IV) contrast agent, and had surgery performed thereafter. Electronic medical records (EMRs) were then reviewed to assess the accuracy of the CT in diagnosing bowel injuries.

The results revealed that CT identified bowel injury in 173 cases, whereas surgery revealed bowel injury in 162 cases. Single-contrast CT had 142 true-positive, 31 false-positive, 81 true-negative, and 20 false-negative cases, resulting in a sensitivity of 88%, a specificity of 72%, a positive predictive value of 82%, and a negative predictive value of 80% for detecting bowel injuries. CT had the highest sensitivity and specificity in patients with multiple GSWs, and those with injuries to the stomach and rectum. The study was published on February 12, 2018, in the American Journal of Roentgenology.

“Many centers advocate use of triple-contrast (IV, oral, and rectal) CT for assessing hemodynamically stable patients with penetrating abdominopelvic trauma. Enteric contrast material has several disadvantages, leading our practice to pursue use of single-contrast IV CT,” concluded lead author Hamza Jawad, MD, of WUSTL, and colleagues. “With accuracy comparable with that reported for triple-contrast CT, single-contrast CT could show bowel injuries in patients with penetrating abdominopelvic trauma.”

Penetrating injuries account for a large percentage of visits to EDs and trauma centers worldwide. CT is now considered an indispensable tool in the evaluation of many patients who are hemodynamically stable, have no clinical indication for exploratory laparotomy, and are candidates for conservative treatment. Triple-contrast (or multidetector CT) may depict the trajectory of a penetrating injury and help determine what type of intervention is necessary on the basis of findings such as active arterial extravasation and major vascular, hollow viscus or diaphragmatic injuries.

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70 (170.94612121582): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294772758 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (127.79235839844): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294772758 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (77.009201049805): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (221.01402282715): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (64.849853515625): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (83.92333984375): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (58.889389038086): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (56.982040405273): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (56.028366088867): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (56.982040405273): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (56.028366088867): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (235.08071899414): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294772758 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (57.93571472168): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294772758 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (59.127807617188): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (82.015991210938): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (65.088272094727): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (74.148178100586): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294772758 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294772758 AND published='1' LIMIT 1

105 (40.054321289062): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294772758 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294772758 AND published='1' LIMIT 1

106 (56.982040405273): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294772758 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (44.107437133789): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294772758 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (215.05355834961): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294772758 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294772758 AND published='1' LIMIT 1

109 (151.15737915039): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294772758 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294772758 AND published='1' LIMIT 1

110 (226.02081298828): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294772758 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (432.96813964844): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294772758 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (622.03407287598): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (329.01763916016): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (89.883804321289): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294772758 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294772758 AND published='1' LIMIT 1

115 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294772758 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294772758 AND published='1' LIMIT 1

116 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294772758 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294772758 AND published='1' LIMIT 1

117 (108.95729064941): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294772758 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294772758 AND published='1' LIMIT 1

118 (48.87580871582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294772758 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294772758 AND published='1' LIMIT 1

119 (37.908554077148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294772758 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294772758 AND published='1' LIMIT 1

120 (277.99606323242): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

121 (!!!!! 51455.974578857): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

122 (95.844268798828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294772758 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294772758 AND published='1' LIMIT 1

123 (43.869018554688): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294772758 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294772758 AND published='1' LIMIT 1

124 (880.00297546387): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294772758 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294772758 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 727272.98736572): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (95.844268798828): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (36.954879760742): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

128 (29.087066650391): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

129 (34.809112548828): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

130 (29.087066650391): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

131 (28.133392333984): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

132 (28.133392333984): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

133 (469.92301940918): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294772758 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

134 (375.03242492676): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294772758 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (231.02760314941): SELECT name FROM jos_deeppockets WHERE id=215

136 (33.855438232422): SELECT name FROM jos_deeppockets WHERE id=215

137 (424.14665222168): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))215((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

138 (339.03121948242): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))215((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

139 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294772758 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294772758 AND published='1' LIMIT 1

140 (81.062316894531): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294772758 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294772758 AND published='1' LIMIT 1

141 (!!!!! 8522.0336914062): TRUNCATE TABLE jos_trademed_module

142 (107.0499420166): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294772758 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

143 (65.803527832031): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294772758 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

144 (905.03692626953): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294772758 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294772758 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

146 (206.94732666016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294772758 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294772758 AND published='1' LIMIT 1

147 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294772758 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294772758 AND published='1' LIMIT 1

148 (!!!!! 1220.9415435791): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

149 (65.088272094727): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294772758 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294772758 AND published='1' LIMIT 1

150 (53.167343139648): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294772758 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294772758 AND published='1' LIMIT 1

151 (66.041946411133): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294772758 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294772758 AND type='deeppockets_item' AND published='1' LIMIT 1

152 (40.054321289062): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=215 or channel_id is null)

153 (31.948089599609): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=215 or channel_id is null)

154 (37.908554077148): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

155 (82.969665527344): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294772758 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294772758 AND published='1' LIMIT 1

156 (47.922134399414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294772758 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294772758 AND published='1' LIMIT 1

157 (48.160552978516): select jos_twitters.link from jos_twitters where cat=10

158 (76.055526733398): select jos_facebook.link from jos_facebook where cat=10

159 (41.961669921875): select jos_google_plus.link from jos_google_plus where cat=10

160 (52.928924560547): select jos_linkedin.link from jos_linkedin where cat=10

161 (360.01205444336): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

162 (!!!!! 1460.075378418): insert into jos_banners_delta values (14615,'2025-06-20 14:46:57','216.73.216.120','view'),(14202,'2025-06-20 14:46:57','216.73.216.120','view'),(14203,'2025-06-20 14:46:57','216.73.216.120','view')

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