Journal List > J Korean Soc Radiol > v.68(1) > 1087258

J Korean Soc Radiol. 2013 Jan;68(1):43-48. Korean.
Published online Jan 29, 2013.  https://doi.org/10.3348/jksr.2013.68.1.43
Copyright © 2013 The Korean Society of Radiology
Penetrating Stab Injuries to the Anterior Abdomen: Use of Multi-Detector Computed Tomography to Predict the Need for Laparotomy
Dae Hong Park, MD, Seung Joon Choi, MD, Yu Mi Jeong, MD, Hyung Sik Kim, MD and Hye-Young Choi, MD
Department of Radiology, Gachon University, Gil Hospital, Incheon, Korea.

Corresponding author: Seung Joon Choi, MD. Department of Radiology, Gachon University, Gil Hospital, 1198 Guwol-dong, Namdong-gu, Incheon 405-760, Korea. Tel. 82-32-460-3060, Fax. 82-32-460-3065, Email: sjchoi@gilhospital.com
Received August 20, 2012; Accepted November 01, 2012.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Abstract

Purpose

The aim of this study was to determine how well multi-detector computed tomography (MDCT) scans predict the need for a laparotomy in patients with anterior abdominal stab injuries.

Materials and Methods

Eighty patients with abdominal stab injuries who underwent MDCT scans were enrolled. MDCT was performed to identify active bleeding and injured organs and to assess the accuracy between MDCT and the laparotomy findings. MDCT was considered positive or negative with respect to the need for an exploratory laparotomy. The diagnostic performance of MDCT for identifying the need for laparotomy was estimated.

Results

MDCT predicted bowel and mesentery injuries in 31 of 80 patients and 28 patients were truly positive. MDCT predicted active bleeding in 23 of 80 patients and 19 patients had active bleeding. MDCT predicted the need for laparotomy in 43 of 80 patients. A laparotomy was performed in 55 of the 80 patients and 42 were therapeutic. Overall, a MDCT scan predicted the need for laparotomy with 95% sensitivity, 92% specificity, and 93% accuracy.

Conclusion

MDCT scans can be used to identify active bleeding and injured organs and are an effective tool for determining the need for surgical exploration.

Keywords: Wounds, Stab; Multi-Detector Computed Tomography; Laparotomy

Figures


Fig. 1
Stab wound to anterior abdomen in a 43-year-old man.

A. CT scan shows defect (thin arrow) in anterior abdominal wall. Hematoma in both paracolic gutter (thick arrows) with contrast material extravasation (arrowhead) in the mesentery is seen.

B. Lower section of the CT scan of the same patient shows bowel wall thickening (black thin arrow) and free intraperitoneal air (white thin arrows). Also seen is streaking of the mesenteric fat adjacent to the thickened bowel (white arrowhead). An injury to the mesenteric vessel and ileum was confirmed surgically.

Click for larger image


Fig. 2
Stab wound to anterior abdomen in a 25-year-old man. CT scan shows defect (thin arrow) in anterior abdominal wall. Free intraperitoneal fluid in mesentery and right paracolic gutter (thick arrows) with linear contrast material extravasation (arrowhead) along right side anterior abdominal wall is seen. No free intraperitoneal air is seen on CT scan. At surgery, an injury to the mesenteric vessel was seen and no bowel injury was found.
Click for larger image


Fig. 3
Stab wound to anterior abdomen in a 33-year-old man. CT scan shows large mesenteric hematoma (thick arrows) including contrast material extravasation (arrowhead) adjacent inferior mesenteric artery (thin arrow). At surgery, transection of proximal inferior mesenteric artery was found.
Click for larger image

Tables


Table 1
Location of Abdominal Stab Wounds
Click for larger image


Table 2
Organ Injuries in 42 Patients with Abdominal Stab Wounds
Click for larger image


Table 3
Scan Findings in Patients with Perforation and Mesenteric Injuries*
Click for larger image


Table 4
Diagnostic Performance of MDCT in Patients with Active Bleeding and Bowel or Mesenteric Injuries
Click for larger image

References
1. Shaftan GW. Indications for operation in abdominal trauma. Am J Surg 1960;99:657–664.
2. Shanmuganathan K, Mirvis SE, Sover ER. Value of contrast-enhanced CT in detecting active hemorrhage in patients with blunt abdominal or pelvic trauma. AJR Am J Roentgenol 1993;161:65–69.
3. Rizzo MJ, Federle MP, Griffiths BG. Bowel and mesenteric injury following blunt abdominal trauma: evaluation with CT. Radiology 1989;173:143–148.
4. Dowe MF, Shanmuganathan K, Mirvis SE, Steiner RC, Cooper C. CT findings of mesenteric injury after blunt trauma: implications for surgical intervention. AJR Am J Roentgenol 1997;168:425–428.
5. Adams DB. Mandatory exploration for penetrating abdominal wounds. Arch Surg 1991;126:115.
6. Nance FC, Cohn I Jr. Surgical judgment in the management of stab wounds of the abdomen: a retrospective and prospective analysis based on a study of 600 stabbed patients. Ann Surg 1969;170:569–580.
7. Nance FC, Wennar MH, Johnson LW, Ingram JC Jr, Cohn I Jr. Surgical judgment in the management of penetrating wounds of the abdomen: experience with 2212 patients. Ann Surg 1974;179:639–646.
8. McAlvanah MJ, Shaftan GW. Selective conservatism in penetrating abdominal wounds: a continuing reappraisal. J Trauma 1978;18:206–212.
9. Leppäniemi AK, Voutilainen PE, Haapiainen RK. Indications for early mandatory laparotomy in abdominal stab wounds. Br J Surg 1999;86:76–80.
10. Salim A, Sangthong B, Martin M, Brown C, Plurad D, Inaba K, et al. Use of computed tomography in anterior abdominal stab wounds: results of a prospective study. Arch Surg 2006;141:745–750.
discussion 750-752.
11. Biffl WL, Kaups KL, Cothren CC, Brasel KJ, Dicker RA, Bullard MK, et al. Management of patients with anterior abdominal stab wounds: a Western Trauma Association multicenter trial. J Trauma 2009;66:1294–1301.
12. Soto JA, Morales C, Múnera F, Sanabria A, Guevara JM, Suárez T. Penetrating stab wounds to the abdomen: use of serial US and contrast-enhanced CT in stable patients. Radiology 2001;220:365–371.
13. Sherck J, Shatney C, Sensaki K, Selivanov V. The accuracy of computed tomography in the diagnosis of blunt small-bowel perforation. Am J Surg 1994;168:670–675.
14. Dauterive AH, Flancbaum L, Cox EF. Blunt intestinal trauma. A modern-day review. Ann Surg 1985;201:198–203.
15. Fakhry SM, Brownstein M, Baker CC, Watts DD, Oller D. Relatively short diagnostic delays produce morbidity and mortality in blunt small bowel injury (SBI): an analysis of time to operative intervention in 202 patients from a multicenter experience. J Trauma 1999;47:207.
16. Demetriades D, Rabinowitz B. Indications for operation in abdominal stab wounds. A prospective study of 651 patients. Ann Surg 1987;205:129–132.
17. Chiu WC, Shanmuganathan K, Mirvis SE, Scalea TM. Determining the need for laparotomy in penetrating torso trauma: a prospective study using triple-contrast enhanced abdominopelvic computed tomography. J Trauma 2001;51:860–868.
discussion 868-869.
18. Shanmuganathan K, Mirvis SE, Chiu WC, Killeen KL, Scalea TM. Triple-contrast helical CT in penetrating torso trauma: a prospective study to determine peritoneal violation and the need for laparotomy. AJR Am J Roentgenol 2001;177:1247–1256.
19. Ramirez RM, Cureton EL, Ereso AQ, Kwan RO, Dozier KC, Sadjadi J, et al. Single-contrast computed tomography for the triage of patients with penetrating torso trauma. J Trauma 2009;67:583–588.
20. Shanmuganathan K, Mirvis SE, Chiu WC, Killeen KL, Hogan GJ, Scalea TM. Penetrating torso trauma: triple-contrast helical CT in peritoneal violation and organ injury--a prospective study in 200 patients. Radiology 2004;231:775–784.
21. Tsang BD, Panacek EA, Brant WE, Wisner DH. Effect of oral contrast administration for abdominal computed tomography in the evaluation of acute blunt trauma. Ann Emerg Med 1997;30:7–13.