Ultrasonography in Hemodynamically Unstable Abdominal Trauma Patients

Abstract

Background A previous study has suggested that emergency laparotomy should be performed in all patients with ultrasound abnormalities plus hemodynamic instability. In this study, we retrospectively reviewed data for patients with blunt abdominal trauma and unstable hemodynamics to determine whether emergency laparotomy is necessary. Materials and Methods We collected data from blunt abdominal trauma patients with hemodynamic instability treated at Chang-Gung Memorial Hospital between January and December 1998. All patients received essential resuscitation treatment and underwent emergency ultrasonographic survey by a senior resident or attending physician. Further management was decided from clinical manifestations and further survey, including enhanced abdominal computed tomography, diagnostic peritoneal lavage, and direct laparotomy. Final diagnosis was made from clinical follow-up data, enhanced computed tomography and surgical findings. Results Free peritoneal fluid was detected in 11 of the 12 patients (92%). The other patient had a lacerated spleen. Lacerations of the liver were diagnosed in three patients and lacerations of the spleen in three. One patient each had a ruptured spleen and ruptured urinary bladder. Seven patients underwent immediate laparotomy and five patients received conservative therapy. All patients survived. Conclusion Emergency ultrasonography is an efficient and safe tool to evaluate patients with suspected blunt abdominal trauma and hemodynamic instability. It is the first choice in blunt abdominal trauma.