Hypoperfusion Complex

  • Etiology:
    — Trauma causing profound systemic vasoconstriction in shock in order to maintain cerebral and coronary perfusion
    — Is reperfusion injury to gut following hypotension and intestinal ischemia
  • Imaging:
    — Small caliber aorta and flattened inferior vena cava
    — Intense renal and adrenal and pancreas enhancement
    — Diffusely dilated fluid-filled thickened bowel loops with intense enhancement
    — May have mesenteric and peritoneal fluid
  • Note: May not see flattened inferior vena cava as patients are often volume resuscitated before being scanned
  • DDX:
  • Complications:
  • Treatment:
  • Clinical:
    — Marker of hypovolemic shock
    — Very poor prognosis as 85% die within 72 hours

Radiology Cases of Hypoperfusion Complex

CT of hypoperfusion complex
Axial CT with contrast of the abdomen shows diffusely dilated intensely enhancing loops of small bowel. The aorta and inferior vena cava are very narrow in caliber. There is a hematoma in the right-sided subcutaneous tissues
CT of hypoperfusion complex / shock bowel in child abuse
Axial CT with contrast of the abdomen shows periportal edema in the liver, diffusely dilated and hyperenhancing loops of small bowel and a narrow caliber inferior vena cava.