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Abstract
The shock bowel sign and the broader CT hypotension complex are frequently triggered by severe systemic hypotension originating from medical conditions other than traumatic haemorrhagic shock. These include cardiac arrest, severe septic shock, neurogenic shock (secondary to critical craniocerebral or spinal cord injuries), bacterial endocarditis, and profound diabetic ketoacidosis (DKA).
The classic vascular and solid visceral elements of the hypoperfusion complex-such as the attenuation of the abdominal aorta and inferior vena cava, abnormal pancreatic contrast dynamics with peripancreatic fluid, and marked hypoperfusion of the liver and spleen-are variably paired with the shock bowel sign, regardless of whether the underlying trigger is post-traumatic blood loss or a medical cause of circulatory failure.
Recognizing the CT hypotension complex carries critical prognostic weight and immediate therapeutic implications, as it guides clinicians toward aggressive volume resuscitation rather than unnecessary operations. In the majority of clinical presentations, these diffuse hypoperfusion features can be successfully distinguished from localized direct bowel trauma or primary ischemic bowel injury.
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References
- Shamji FM, Todd TR. Hypovolemic shock. Crit Care Clin 1985;1(3):609-29.
- Bulkley GB, Kvietys PR, Parks DA, et al. Relationship of blood flow and oxygen consumption to ischemic injury in the canine small intestine. Gastroenterology 1985;89(4):852-7.
- Wang J, Liang T, Louis L, et al. Hypovolemic shock complex in the trauma setting: a pictorial review. Canadian Association of Radiologists Journal 2013;64:156-63.
- Tarrant AM, Ryan MF, Hamilton PA, et al. A pictorial review of hypovolaemic shock in adults. Br J Radiol 2008;81(963):252-7.
- Taylor GA, Fallat ME, Eichelberger MR. Hypovolemic shock in children: abdominal CT manifestations. Radiology 1987;164:479-81.
- Mirvis SE, Shanmuganathan K, Erb R. Diffuse small-bowel ischemia in hypotensive adults after blunt trauma (shock bowel): CT findings and clinical significance. AJR Am J Roentgenol 1994;163(6):1375-9.
- Ryan MF, Hamilton PA, Sarrazin J, et al. The halo sign and peripancreatic fluid: useful CT signs of hypovolaemic shock complex in adults. Clin Radiol 2005;60(5):599-607.
- Hara H, Babyn PS, Bourgeois D. Significance of bowel wall enhancement on CT following blunt abdominal trauma in childhood. J Comput Assist Tomogr 1992;16(1):94-8.
- Mirvis SE, Gens DR, Shanmuganathan K. Rupture of the bowel after blunt abdominal trauma: diagnosis with CT. AJR 1992;159(6):1217-21.
- Aschoff AJ, Stuber G, Becker BW, et al. Evaluation of acute mesenteric ischemia: accuracy of biphasic mesenteric multi-detector CT angiography. Abdom Imaging 2009;34(3):345-57.
- Hyland R, Chalmers A. CT features of jejunal pathology. Clin Radiol 2007;62(12):1154-62.
- Kirkpatrick ID, Kroeker MA, Greenberg HM. Biphasic CT with mesenteric CT angiography in the evaluation of acute mesenteric ischemia: initial experience. Radiology 2003;229(1):91-8.
- Landreneau RJ, Fry WJ. The right colon as a target organ of nonocclusive mesenteric ischemia: case report and review of the literature. Arch Surg 1990;125(5):591-4.
- Tarrant AM, Ryan MF, Hamilton PA, et al. A pictorial review of hypovolaemic shock in adults. Br J Radiol 2008;81(963):252-7.
- Catalano OA, Napolitano M, Vanzulli A. Black kidney sign: a new computed tomographic finding associated with the hypoperfusion complex in children. J Comput Assist Tomogr 2005;29(4):484-6.
- Lubner M, Demertzis J, Lee JY, et al. CT evaluation of shock viscera: a pictorial review. Emerg Radiol 2008;15(1):1-11.
- Brochert A, Rafoth JB. Shock thyroid: a new manifestation of the hypovolemic shock complex in trauma patients. J Comput Assist Tomogr 2006;30(2):310-12.
References
Shamji FM, Todd TR. Hypovolemic shock. Crit Care Clin 1985;1(3):609-29.
Bulkley GB, Kvietys PR, Parks DA, et al. Relationship of blood flow and oxygen consumption to ischemic injury in the canine small intestine. Gastroenterology 1985;89(4):852-7.
Wang J, Liang T, Louis L, et al. Hypovolemic shock complex in the trauma setting: a pictorial review. Canadian Association of Radiologists Journal 2013;64:156-63.
Tarrant AM, Ryan MF, Hamilton PA, et al. A pictorial review of hypovolaemic shock in adults. Br J Radiol 2008;81(963):252-7.
Taylor GA, Fallat ME, Eichelberger MR. Hypovolemic shock in children: abdominal CT manifestations. Radiology 1987;164:479-81.
Mirvis SE, Shanmuganathan K, Erb R. Diffuse small-bowel ischemia in hypotensive adults after blunt trauma (shock bowel): CT findings and clinical significance. AJR Am J Roentgenol 1994;163(6):1375-9.
Ryan MF, Hamilton PA, Sarrazin J, et al. The halo sign and peripancreatic fluid: useful CT signs of hypovolaemic shock complex in adults. Clin Radiol 2005;60(5):599-607.
Hara H, Babyn PS, Bourgeois D. Significance of bowel wall enhancement on CT following blunt abdominal trauma in childhood. J Comput Assist Tomogr 1992;16(1):94-8.
Mirvis SE, Gens DR, Shanmuganathan K. Rupture of the bowel after blunt abdominal trauma: diagnosis with CT. AJR 1992;159(6):1217-21.
Aschoff AJ, Stuber G, Becker BW, et al. Evaluation of acute mesenteric ischemia: accuracy of biphasic mesenteric multi-detector CT angiography. Abdom Imaging 2009;34(3):345-57.
Hyland R, Chalmers A. CT features of jejunal pathology. Clin Radiol 2007;62(12):1154-62.
Kirkpatrick ID, Kroeker MA, Greenberg HM. Biphasic CT with mesenteric CT angiography in the evaluation of acute mesenteric ischemia: initial experience. Radiology 2003;229(1):91-8.
Landreneau RJ, Fry WJ. The right colon as a target organ of nonocclusive mesenteric ischemia: case report and review of the literature. Arch Surg 1990;125(5):591-4.
Tarrant AM, Ryan MF, Hamilton PA, et al. A pictorial review of hypovolaemic shock in adults. Br J Radiol 2008;81(963):252-7.
Catalano OA, Napolitano M, Vanzulli A. Black kidney sign: a new computed tomographic finding associated with the hypoperfusion complex in children. J Comput Assist Tomogr 2005;29(4):484-6.
Lubner M, Demertzis J, Lee JY, et al. CT evaluation of shock viscera: a pictorial review. Emerg Radiol 2008;15(1):1-11.
Brochert A, Rafoth JB. Shock thyroid: a new manifestation of the hypovolemic shock complex in trauma patients. J Comput Assist Tomogr 2006;30(2):310-12.