図１７〜図２０と図３７〜図４０は省略．図１と図２で肝臓周囲に腹水（※）があるが，明らかな遊離ガスは認めない．図７〜図１２の△はextravasationであり，回盲部あたりの腸間膜損傷（出血）を意味する．図１３〜図１６のやや高濃度の腹水（※）は出血を裏付ける． 液状内容物を含む小腸は麻痺性イレウスを示唆し，消化管穿孔の合併を疑う．S：Ｓ状結腸．

活動性出血の所見を見落とされ，腹部が次第に膨満してきたので3時間後にCT再検査が行われた．下段のCTでextravasationは認めなくなったが，胃液より高濃度の腹水（※）が増量し，さらに図２２と図２３で遊離ガス（↑）が出現し，消化管穿孔の診断がついた．開腹したら活動性の出血はなかったが，約1000mlの出血量，盲腸から20cmの部位で50cm長の腸間膜裂創と回腸の完全断裂（離断，図A：▲）を認めた．

文献考察：見落とされた外傷所見．8.1%に外傷の見落としがあった．見落としの原因または誘因となった状況は表１，身体部位は表２，臓器別は表３，時間帯と治療は表４，重大深刻と思われた10症例の特徴は表５．
１）J Trauma. 2002 Apr;52(4):715-9.
Missed injuries in a level I trauma center.
Houshian S, Larsen MS, Holm C.

BACKGROUND: Major trauma presents major diagnostic and therapeutic problems. Any delay in providing the treatment necessary may lead to increased morbidity and mortality, prolonged length of hospital stay, and increased cost. This study was undertaken to determine the extent, contributing factors, and implication of missed injuries and relate them to the three surveys in a Danish Level I trauma center. METHODS: The records of all major traumatized patients admitted to the Odense University Hospital from January 1996 through December 1999 have been studied to determine the extent and type of missed injuries. The initial examination is carried out by the trauma team in the A&E department according to standard protocols. Resuscitation is carried out according to Advanced Trauma Life Support principles and details are documented in the patient journal and in a special trauma journal. RESULTS: Sixty-four of 786 patients (incidence, 8.1%) had 86 missed injuries. The missed injuries averaged 1.3 injuries per patient. There were 45 male and 19 female patients, with a median age of 33 years (range, 12-81 years). The median ISS was 17 (range, 4-50); 14%, 38%, and 48% of the injuries were missed in primary, secondary, and tertiary surveys, respectively. CONCLUSION: Our study demonstrates that missed injuries can occur at any stage of the management of patients with major trauma. Repeated assessments, both clinical and radiologic, are mandatory to diminish the problem. In initial assessment, one still has to treat the greatest threat to life before complete diagnosis of all injuries, but alertness to evolving injuries must remain throughout the patient's stay in hospital.PMID: 11956389

文献考察：見落とされた外傷所見．上記文献同様8.1%に外傷の見落としがあった．身体部位は表６，臓器別は表７．
２）J Trauma. 2000 Oct;49(4):600-5.
Missed injuries in patients with multiple trauma.
Buduhan G, McRitchie DI.

BACKGROUND: Understanding the etiology of missed injuries is essential in minimizing its occurrence. A retrospective review was conducted to identify the incidence, contributing factors, and clinical outcomes of missed injuries. METHODS: All trauma patients assessed by St Michael's Hospital trauma service from April 1, 1995, to July 31, 1997, were included in the study. Demographic and medical data were compared and statistically analyzed in two patient groups to identify factors associated with missed injuries. RESULTS: Forty six of 567 patients (8.1%) had missed injuries. Patients with missed injuries had higher mean Injury Severity Scores and longer stays in the hospital and intensive care unit compared with patients without missed injuries (p