A computed tomographic (CT) sign of occult intestinal rupture in blunt abdominal trauma. A streaky density in the mesentery of the small intestine on an unprepped CT is 100% specific for intestinal rupture usually on the anti-mesenteric border. No streaky density within the mesentery was found in patients without small intestinal rupture in a study from Kyorin University, Tokyo, of 430 patients within 3 hours of blunt abdominal trauma. Fifty-five percent of the patients with the streaky density sign did not have free air. Contusion of the mesentery with hemorrhage and edema along the rectus arteries produced the sign. Contact with the steering wheel was a significant finding in the motor vehicle accident (MVA) patients with intestinal rupture. J. Trauma 38:630, 1995. This sign may be useful in detecting occult intestinal injuries in patients involved in MVAs with airbag restraints. Severe abdominal injuries may be present in airbag-protected occupants who appear uninjured at the scene. Dr. Augenstein notes that deformation of the steering wheel is an indicator of an increased chance of internal injury and may be used as a triage guide. A strategy has been developed of not only looking at the patient, but looking at the crash situation and the contents of the car to determine the possibility of injury. J. Trauma 38:502, 1995.
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