MDCT In Blunt Abdominal Trauma, A Good Predictor For Surgical Management
MDCT In Blunt Abdominal Trauma
DOI:
https://doi.org/10.70284/njirm.v5i2.694Keywords:
Multidetector computed tomography, blunt abdominal traumaAbstract
Aim: The aim of our study was to analyze the role of Multidetector computed Tomography (MDCT) in the classification and management of high energy blunt abdominal trauma. Material And Method: A Prospective study of 140 patients of all age groups was conducted from October 2010 to October 2012. Rectal and IV contrast were used. Angiography was performed in cases of suspected vascular trauma. Three dimensional reconstructions were done. CT findings were correlated and confirmed by either operative findings or follow-up CT. Result: 140 cases of blunt abdominal trauma were included in this study. Abdominal USG (Ultrasound) and MDCT were performed. Abdominal injuries were more common in males seen in 119 cases (89%). Spleen was the most common organ to be injured, affected in 40 patients (23%). Liver injury was seen in 36 cases, renal involvement in 30 cases, bowel in 20 cases, urinary bladder in 7 cases, a pancreatic injury in 3 cases and retro peritoneum involvement in 2 cases. Out of 140 patients 135 had free intraperitoneal fluid. USG findings and MDCT findings were compared with per operative findings. Patients managed conservatively were compared with repeat follow up CT findings. USG showed a sensitivity of 55 % and specificity of 75 % in solid organs injury and sensitivity of 95 % and specificity of 99 % in free fluid detection. MDCT showed a sensitivity of 97 % and specificity of 98 % in solid organs injury and 100%in hemoperitoneum.
Conclusion: MDCT is the modality of choice to evaluate abdominal injury when there is doubt in clinical and USG findings, and to offer patient conservative management. [ Vaishnav K et al NJIRM 2014; 5(2) :19-26]
References
2. Moore EE, Cogbill TH, Jurkovich GJ, et al. Organ injury scaling: Spleen and liver (1994 revision). Journal Trauma 1995; 38:323-4.
3. Manorama Berry, Sima mukhopadhyay, Veena chaudhry. Diagnostic Radiology, Gastrointestinal imaging 3rd edition, page 37-50.
4. Croce MA, Fabian TC, Menke PG, et al: Nonoperative management of blunt trauma is the treatment of choice for hemodynamically stable patients. Results of a prospective trial. Ann Surg 221:744-755,1995.
5. Demetriades D, Gomez H, Chahwan S, et al: Gunshot injuries to the liver: The role of selective nonoperative management. J Am Coll Surg 188:343-348, 1999.
6. Malhotra AK, Fabian TC, Croce MA, et al: Blunt hepatic injury: A paradigm shift from operative to nonoperative management in the 1990s. Ann Surg 231:804-813, 2000.
7. Fakhry S, Watts D, Luchette FA for the EAST Multi-Institutional HVI Research Group. Current diagnostic approaches lack sensitivity in the diagnosis of perforated blunt small bowel injury: Analysis from 275,557 trauma admissions from the EAST Multi-Institutional HVI Trial. J Trauma 2003; 54:295-306.
8. Fakhry SM, Browstein M, Watts DD, et al. Relatively short diagnostic delays (<8 hours) produce morbidity and mortality in blunt small bowel injury: an analysis of time to operative intervention in 198 patients from a multicenter experience. J Trauma 2000; 48:408-14.
9. Kane NM, Francis IR, Burney RE, et al. Traumatic Pneumoperitoneum: Implications of CT diagnosis. Invest Radiol 1991; 26(6):574-8.
10. Sandler CM, Hall JT, Rodriguez MB, et al. Bladder injury in blunt pelvic trauma. Radiology 1986;158:633-38.
11. Federle MP, Goldberg HI, Kaiser JA, et al. Evaluation of abdominal trauma by computed tomography. Radiology 1981; 138(3):637-44.
12. Weil PH. Management of retroperitoneal trauma. Curr Prob surg 1984; 20:545.
13. Heiberg E, Wolverson MK, Hud RN, et al, CT recognition of traumatic rupture of the diaphragm. AJR 1980;135:369-72.
14. Hill SA, Jackson MA, Fitz Gerald. Abdominal wall haematoma mimicking visceral injury: The role of CT scanning. Injury 1995; 26(9):605-7.
15. Nance ML, Peden GW, Shapiro MB, et al: Solid viscus injury predicts major hollow viscus injury in blunt abdominal trauma. J Trauma 43:618-623, 1997.
