Diagnosis Of Blunt Abdominal Trauma Research Articles

Sonography versus Peritoneal Lavage in Blunt Abdominal Trauma

The reliability of sonography and peritoneal lavage in assessing the need for immediate surgical intervention in blunt abdominal trauma was examined in a prospective study (n = 71). Statistical analysis revealed a sensitivity of 100% for peritoneal lavage compared to 84% for sonography; the accuracy was 99% versus 86%, the predictive value 97% vs. 89%. The statistical difference was significant (p less than 0.05). The results demonstrate that sonography cannot replace peritoneal lavage in the diagnosis of blunt abdominal trauma. The discussion of the advantages and disadvantages of both methods shows that sonography and peritoneal lavage are not competing, but rather, are complementary examinations.

Evaluation of ultrasound, lavage, and computed tomography in blunt abdominal trauma.

We have analysed the data of 136 patients with multiple injuries treated between 1983 and 1988 in order to assess the sensitivity, specificity, and accuracy of ultrasound, lavage and computed tomography (CT) for the preoperative diagnosis of blunt abdominal trauma. CT was carried out in doubtful cases (n = 29) if ultrasound and lavage had not provided sufficient information. Fifty-eight patients were primarily excluded from the study because neither clinical examination nor ultrasound gave any sign of an intra-abdominal lesion. In 25 cases, sonography could be compared with lavage, CT, and the intraoperative situs. Ultrasound showed reliable results in respect to accuracy (100%), sensitivity (84%), and specificity (98%). Computed tomography confirmed all sonographic diagnoses in 29 patients but did not provide further information. Peritoneal lavage gave correct information in all patients operated upon. Our 5-years' experience suggests that ultrasound is a reliable, quick, cheap, and repeatable technique of great value in patients with blunt abdominal traumata.

The Impact of Computed Tomography Scanning on the Child With Renal Trauma

A six-year experience using computed tomography(CT) in the diagnosis of blunt abdominal trauma was reviewed to assess the impact of CT scanning on a patient with renal injury. Three questions were evaluated: (1) Does the increased sensitivity of the CT scan heter the indications for surgery? (2) Does the CT scan help predict the course and eventual outcome of nonoperative therapy? (3) Are there circumstances when the CT scan is not the most efficient and cost effective method of diagnosis? One hundred seventy six consecutive patients with suspected renal trauma were reviewed. One hundred thirty eight were evaluated by CT scan and IVP, the other 38 by exretory urogram alone. Forty four renal injuries were identified. Four of these patients required urgent surgery and four others required later operation for unsuspected congenital anomalies. The injuries sustained by the other 36 cases resolved without surgery. Each patient has been followed for 1 to 5 years following their trauma, and their status assessed by questionnaire and physical examination. The CT technique provides better definition of the injury upon which to base the decision to operate or to enter the patient into nonoperative management. The extravasation seen on CT scan is frequently exaggerated and should not be an absolute indication for exploration. The scan provides improved follow-up data as to completeness of healing and allows directions to be given to the parents concerning resumption of full physical activities. The patients with asymptomatic posttraumatic hematuria, have in our experience, a very low incidence of intraperitoneal or retroperitoneal injuries. Therefore, these patients do not require the advantages of CT scan and may be screened by the less expensive intravenous pyelogram.

The impact of computed tomography scanning on the child with renal trauma

A six-year experience using computed tomography (CT) in the diagnosis of blunt abdominal trauma was reviewed to assess the impact of CT scanning on a patient with renal injury. Three questions were evaluated: Does the increased sensitivity of the CT scan alter the indications for surgery? Does the CT scan help predict the course and eventual outcome of nonoperative therapy? Are there circumstances when the CT scan is not the most efficient and cost effective method of diagnosis? One hundred seventy six consecutive patients with suspected renal trauma were reviewed. One hundred thirty eight were evaluated by CT scan and IVP, the other 38 by excretory urogram alone. Forty four renal injuries were identified. Four of these patients required urgent surgery and four others required later operation for unsuspected congenital anomalies. The injuries sustained by the other 36 cases resolved without surgery. Each patient has been followed for 1 to 5 years following their trauma, and their status assessed by questionnaire and physical examination. The CT technique provides better definition of the injury upon which to base the decision to operate or to enter the patient into nonoperative management. The extravasation seen on CT scan is frequently exaggerated and should not be an absolute indication for exploration. The scan provides improved follow-up data as to completeness of healing and allows directions to be given to the parents concerning resumption of full physical activities. The patients with asymptomatic posttraumatic hematuria, have in our experience, a very low incidence of intraperitoneal or retroperitoneal injuries. Therefore, these patients do not require the advantages of CT scan and may be screened by the less expensive intravenous pyelogram.

Diagnostic peritoneal lavage: technical aspects, and its place in blunt abdominal trauma.

The use of peritoneal lavage as an adjunct in the diagnosis of blunt abdominal trauma is now well established. It is especially useful when clinical findings are equivocal, or when the trauma patient is uncooperative as a result of head injury or alcohol abuse. However, to achieve a high degree of accuracy the finer points of technique must be rigidly adhered to. In the series presented there were no false-negatives, and the single false-positive was caused by a technical failure due to the use of an unsatisfactory catheter with a sharp trocar.

The dominant role of paracentesis technics in the early diagnosis of blunt abdominal trauma

A simplified method of diagnostic abdominal paracentesis and lavage is described. Liberal application of this method as part of the initial physical examination of blunt trauma patients resulted in identification at first examination of 94 per cent (61 of 65) of those who were to have laparotomy. No case in the series was brought to laparotomy as the result of findings at arteriography, radionuclide imaging, or sonarography, and no intraabdominal problem was missed because of failure to use one of these organ-imaging technics. The very limited role of these imaging procedures in early management of blunt abdominal trauma is discussed.

Peritoneal lavage in blunt abdominal trauma

Diagnosis of blunt abdominal trauma is frequently complicated by the presence of associated multiple system injuries. Diagnostic needle paracentesis has been advocated by numerous authors for many years. If nonclotting blood is recovered from the peritoneal cavity after taps in two or four quadrants, the accuracy of this adjunctive procedure has been reported as high as 95 per cent in predicting intraabdominal injury. The chance of obtaining positive results of the tap seems to be directly related to the amount of blood in the peritoneal cavity. Paracentesis is a simple quick procedure that has relatively few complications. Although abdominal paracentesis is accurate if results are positive, no information is gained if the result is negative. The major objection to the use of this test is the high percentage of falsenegative results. Because of the lack of reliability attached to negative results on paracentesis, other procedures have been sought to detect intra-abdominal injury. Canizaro, Fitts, and Sawyer [I] described the use of intraperitoneal saline infusions in animals in 1964. They consistently recovered blood-stained fluid in those animals which previously had blood injected into the peritoneal cavity and subsequently had negative results on abdominal paracentesis. In 1965 Root et al [2] described the technic of peritoneal lavage in patients. A follow-up study published in 1970 reported 304 patients in whom a 96 per cent accuracy rate was obtained [3]. This stimulated the intro-