A polytrauma patient in profound hypovolaemic shock undergoes whole-body CT. Findings include a flattened inferior vena cava, small calibre aorta, diffusely hyperenhancing adrenal glands, poorly enhancing spleen, and diffuse bowel wall thickening with increased mucosal enhancement. What is this constellation called and what does it signify?

• A Shock bowel syndrome caused by mesenteric venous thrombosis requiring anticoagulation
• B Hypoperfusion complex, indicating severe hypovolaemic shock needing immediate resuscitation ✓
• C Systemic inflammatory response from occult sepsis, indicating empirical antibiotics
• D Anaphylactoid reaction to iodinated contrast, indicating steroid premedication next time

Explanation

The hypoperfusion complex reflects intense endogenous catecholamine-driven splanchnic vasoconstriction and volume depletion: collapsed IVC and aorta, hyperenhancing adrenals and pancreas, hypoenhancing spleen, and hyperenhancing thick-walled bowel (shock bowel). Its presence on CT warns the clinician that the patient is in decompensated shock even if vital signs appear compensated, prompting aggressive resuscitation and search for ongoing haemorrhage. Mesenteric venous thrombosis and sepsis do not produce the collapsed central vessels and adrenal hyperenhancement that define this entity.

Reference: Radiology Review Manual by Wolfgang Dähnert, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.