Role of abdominal computed tomography in the evaluation and management of stab wounds to the back and flank

Abstract

The purpose of this study was to examine the role of abdominal computed tomography (CT) in the evaluation and management of stab wounds to the back and flank. We retrospectively studied 62 patients with nonsuperficial stab wounds to the back and flank who presented without signs of peritonitis or hemodynamic instability. Twenty-seven patients had conventional CT with oral and intravenous contrast medium administration. Twenty-seven patients had CT with oral, intravenous, and rectal contrast medium, which is called “triple contrast CT” (TCCT). Eight patients had CT with oral and intravenous contrast medium with the addition of air insufflated rectally. Patients with no CT evidence of intra-abdominal injury or with evidence of visceral injury that was considered minor were initially treated with observation. Patients with CT evidence of surgically significant injury received immediate celiotomy. The results of laparotomy and/or patient follow-up were used to determine the sensitivity and specificity of CT for classification of patients into operative or nonoperative categories. For proper classification of patients into operative or nonoperative categories, conventional CT and CT with rectal contrast demonstrated nearly identical sensitivities of 100%, specificities of 96%, and accuracies of 96%. The results were similar for the group that received rectal air. Combining all patients, CT demonstrated a sensitivity of 100%, a specificity of 96%, and an accuracy of 97%. The negative predictive value was 100%, and only 2 of the 62 patients (3.2%) received nontherapeutic laparotomies. CT is useful in the routine management of hemodynamically stable patients with nonsuperficial stab wounds to the back and flank.