Diagnosis and pre-operative management of multiple injured patients with explorative laparotomy because of blunt abdominal trauma

Abstract

Introduction: In trauma patients, injury of solid abdominal organs secondary to blunt trauma is a major source of morbidity and mortality. Different diagnostic options such as FAST sonography or CT scan have been described.

Methods: Our trauma registry was used to identify multiple injured patients with blunt abdominal trauma during 2001 to 2006. Patient demographics, diagnostic and operative findings, treatment, complications, length of stay and mortality were reviewed.

Results: Of 438 multiple injured patients, 58 patients were diagnosed with blunt abdominal trauma. During examination, free fluid or organ injury could be seen in 72.4% during sonography and in 84.3% of the patients who received CT scan, giving a sensitivity of 92% for initial FAST Sonography. Nevertheless, CT scan showed a higher sensitivity in detecting bowel (84%) or mesenteric (75%) injuries, if compared to FAST. 30 (51.7%) of the 58 patients had to undergo laparotomy because of blunt abdominal trauma, giving a laparotomy rate of 6.8% because of blunt abdominal trauma in multiple injured patients.

Conclusion: Sonography is the method of choice for initial screening and CT scan in detecting bowel or mesenteric injuries. A large intraperitoneal fluid accumulation during initial sonography in combination with unstable vital signs should lead to an immediate exploratory laparotomy.