What is the diagnostic value of computed tomography tractography in patients with abdominal stab wounds?

Abstract

Computed tomography (CT) tractography is a promising technique; it is a CT performed after an entire stab wound tract with a water-soluble contrast agent in patients with abdominal stab wounds. The aim of the current study was to investigate the diagnostic value of CT tractography and to compare with other radiodiagnostic tools in patients with abdominal stab wounds. All of the patients with anterior abdominal stab wounds were retrospectively reviewed between January 2012 and December 2014. Included in this study for statistical analyses were patients who had contrast-enhanced (oral and intravenous, not rectal) abdominal CTs alone or had contrast-enhanced abdominal CTs combined the CT tractographies and laparotomies in the first 24h. These patients were divided two groups: the CT scan group (patients who had abdominal CTs alone) and the CT tractography group (patients who had CT tractographies). Both groups underwent laparotomies. The endpoint of this study was to determine whether CT tractography predicted peritoneal violation, not requiring therapeutic laparotomy. The gold standard of diagnosis peritoneal violation was considered laparotomy (therapeutic or not therapeutic). A total of 102 patients with anterior abdomen stab wounds who had laparotomies were enrolled and 29 (27%) of the patients were excluded for several causes in the study period. Finally, 73 of the patients were enrolled in this study for statistical analyses. The diagnostic performance of a CT tractography in detecting peritoneal violation resulted in 100% sensitivity, 100% specificity, 100% positive predictive values (PPV), 100% negative predictive values (NPV), and 100% accuracy. A CT tractography combined with an abdominal CT scan seems successful in detecting peritoneal violation in hemodynamically stable patients with abdominal stab wounds. Certainly, randomized controlled trials are required on this topic to recommend this as a routine diagnostic procedure.