The use of computerized axial tomography versus peritoneal lavage in the evaluation of blunt abdominal trauma: a prospective study

Abstract

Computerized axial tomography (CAT) of the abdomen was prospectively compared with peritoneal lavage (PL) in 19 patients who sustained acute blunt abdominal trauma. All were selected carefully and were deemed stable, never having been in shock, and all required diagnostic PL. Seven patients underwent exploratory laparotomy on the basis of CAT and PL findings. There were no negative findings at laparotomy. Three significant splenic injuries, one hepatic laceration, and two hemoperitoneums were undetected by CAT. All seven cases explored were preceded by a grossly positive PL. Thus no major injury would have been missed if PL had been used alone. There were no complications of PL but one patient aspirated oral contrast medium and one patient developed hypotension during CAT. Open PL required one half the time (20.6 minutes) as CAT (47.4 minutes). The total cost of CAT was approximately eight times that of PL ($900.01 versus $116.38). In our hands, PL would seem to be significantly more sensitive with fewer false negative results than CAT of the abdomen in acute blunt abdominal trauma, a deviation from results of earlier reported series. CAT alone would have added cost, time, some risk, and very little information of use that would not be obtained by PL followed by surgery. Therefore before CAT replaces PL in the evaluation of adult patients with blunt abdominal trauma, we feel that additional prospective studies are needed to better define the accuracy and sensitivity of CAT as compared with PL with regard to intraperitoneal injuries.