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. 2010 Sep;92(6):486-8.
doi: 10.1308/003588410X12699663903511. Epub 2010 Jun 1.

Avoiding cavity surgery in penetrating torso trauma: the role of the computed tomography scan

J E Smith  1 , M Midwinter, A W Lambert
Affiliations

Avoiding cavity surgery in penetrating torso trauma: the role of the computed tomography scan

J E Smith et al. Ann R Coll Surg Engl. 2010 Sep.

Abstract

Introduction: Surgical decision-making in torso trauma is complex. This paper looks at the role of the computed tomography (CT) scan in this decision-making process.

Patients and methods: Patients with significant torso trauma (high velocity gunshot wound [HVGSW], blast, stab) admitted to a military role 2 (enhanced) hospital facility during a 7-week period of Operation HERRICK 9 (Afghanistan, October to November 2008) are reported. The management of those patients undergoing a CT scan as part of the decision-making process at the time of admission is discussed.

Results: Twenty eight patients with significant torso trauma were admitted to the facility during the study period; HVGSW (n = 15), blast (n = 9), stab (n = 4). Thirteen patients underwent a CT scan as part of the surgical decision-making process; HVGSW (n = 5), blast (n = 8). Imaging confirmed torso integrity in 12 patients, one of whom subsequently had a laparotomy for vascular control for on-table haemorrhage during lower limb surgery. One patient had a confirmed thoraco-abdominal injury, which was treated conservatively with tube thoracostomy and 'active observation'.

Conclusions: A CT scan formed part of the surgical decision-making process in about half of the patients admitted with significant torso trauma, and helped prevent unnecessary laparotomy in this forward military environment. Those patients with a blast injury were more likely to undergo CT scanning than those where the mechanism of injury was a HVGSW.

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Figures

Figure 1
Figure 1
The trauma chest X-ray demonstrates a pneumothorax with debris along the line of the ballistic tract, which extends below the diaphragm (circled with arrows identifying debris).
Figure 2
Figure 2
The post-chest drain CT scan demonstrates air in the soft tissues of the right side of the neck (circled) with fragments and contusion at the lung apex (A); haemopneumothorax with fragments inside the chest, see arrow (B); and a small fragment anterior to a vertebral body within the abdomen, circled (C).
See this image and copyright information in PMC

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