Ashwin V. Asrani MD, Presenter: Nothing to Disclose

Jamlik-Omari Johnson MD, Abstract Co-Author: Nothing to Disclose

Rathachai Kaewlai MD, Abstract Co-Author: Nothing to Disclose

Laura Louise Avery MD, Abstract Co-Author: Nothing to Disclose

Robert Arthur Novelline MD, Abstract Co-Author: Nothing to Disclose

For several decades computed tomography has been the diagnostic procedure of choice for patients with blunt abdominal trauma. In recent years there has been increased interest in the evaluation of penetrating trauma with CT. The authors performed a retrospective investigation to evaluate the role of CT in penetrating abdominal injuries in a level 1 trauma center with special interest in determining whether CT could predict patients who would require laparotomy versus those who would not.

A retrospective review of all patients presenting with penetrating abdominal trauma at our level 1 trauma center between January 2002 and October 2006 (58 months)was performed. The findings at CT were compared to the findings at surgery, clincal follow up and/or final diagnosis. All MDCT scans were performed with triple contrast technique using oral, rectal and intravenous contrast.

Between January 2002 and October 2006, 238 patients were brought to our level 1 trauma center with penetrating trauma. 175 (73.5%) were examined with computed tomography. The ages of patients ranged from 13-65 years with a mean age of 26.6 years. There were 171 men (97.7%) and 4 women (2.3%. 137(78.3%) sufferred stab injuries, 36(20.5%) sufferred gunshot wounds and 2(1.1%)were impaled by sharp objects. The most common parenchymal injuries included the liver 6.3% (11 of 175), spleen 3.4%(6 of 175), kidney 3.4%(6 of 175)and pancreas 1.7%(3 of 175). Bowel injuries were identified in 6.8% cases(12 of 175). CT indicated the need for laparotomy in 35 cases(20%) and no laparotomy in 140 cases (80%) cases. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CT in predicting laparotomy were 96.7%, 96.5%, 96.5%, 85.7% and 99.2% respectively.

Triple contrast MDCT is a valuable imaging procedure in prediciting the need for exploratory lapaporotomy in patients with penetrating abdominal trauma with an accuracy of 96.5% and negative predictive value of 99.2%.

Triple contrast multidetector CT is recommended for the triage of hemodynamically stable patients with penetrating abdominal trauma and is a strong predictor of the need for exploratory laparotomy.

Asrani, A, Johnson, J, Kaewlai, R, Avery, L, Novelline, R, Triple Contrast MDCT in the Triage of Penetrating Abdominal Trauma: Experience with 175 Cases.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5009792.html