Triple-contrast computed tomography in the evaluation of penetrating posterior abdominal injuries
C. J. Hauser, J. E. Huprich, P. Bosco, L. Gibbons, A. Y. Mansour and A. R. Weiss
Division of Trauma, Hollywood Presbyterian Medical Center, Los Angeles, CA 90027.
Routine exploration of stable patients who have penetrating injuries of the
posterior abdomen results in a high rate of unnecessary operation.
Prolonged observation, while safe, is expensive and potentially morbid in
the event that a retroperitoneal injury has occurred and treatment is
delayed. To evaluate these injuries, we have developed and employed a
protocol for computed tomographic (CT) scanning of the abdomen employing
oral, intravenous, and rectal administration of contrast material to
visualize the retroperitoneal contents. Between Jan 1, 1985, and Dec 1,
1986, 40 patients were studied in this manner. In each case, the path of
penetration could be determined exactly by tracing the course of air and
hematoma through the tissues. All retroperitoneal organs could be evaluated
well enough to exclude injuries requiring intervention. The majority of
patients showed subcutaneous penetrations only. All six significant
intra-abdominal injuries were diagnosed correctly and confirmed at
laparotomy. All 34 patients deemed by CT not to have significant injury
were observed for 72 hours, and all were discharged uneventfully.
Triple-contrast CT appears to be of great value in the triage of
penetrating posterior abdominal trauma into operative and nonoperative
groups.
