Intra-abdominal insufflation as a diagnostic modality for penetrating anterior abdominal wall trauma in a busy urban center: a retrospective case-series

Abstract

Background: The optimal algorithm for evaluating patients with anterior abdominal stab wounds (AASW) is not clear and has been a long standing controversy. Currently, the workup and management of penetrating anterior abdominal wall trauma may involve the decision to proceed immediately to surgery based on the presentation of the patient, or the work up may involve local wound exploration (LWE), focused abdominal sonography for trauma (FAST) exam, CT scan, or serial abdominal exams. Here we discuss an observational sign utilizing the Veress needle intra-abdominal insufflation test that can be used in conjunction with the current AASW algorithm, to rule in peritoneal violation. Methods: Eight patients admitted to our level 1 trauma center with penetrating AASW were evaluated using LWE, FAST, or CT scan followed by Veress needle insufflation and DL for suspected intra-abdominal injuries. These cases were retrospectively evaluated for the efficacy of Veress needle insufflation as an observational test for peritoneal violation. Results: Eight hemodynamically stable patients from December 2013 to June 2014 presented to our level one trauma center after sustaining penetrating AASW. All eight patients went to the operating room for Veress needle insufflation and DL. Upon intra-abdominal insufflation using a Veress needle to a target pressure of 15 mmHg, all patients with peritoneal violations [5] were found to have CO2 escape from their wounds. The remaining three patients with no violation to the peritoneum did not have any appreciable CO 2 escape. Conclusions: Utilizing our technique of intra-abdominal insufflation combined with monitoring for CO 2 escape, we were able to successfully identify all patients with peritoneal violation and rule out violation in those without peritoneal injuries. With further research, our technique can be used to safely, accurately and in a timely manner stratify patients for the need of further diagnostic and interventional procedures.