Diagnostic Yield and Clinical Utility of Abdominopelvic CT Following Emergent Laparotomy for Trauma

Abstract

Purpose To determine the incidence of unexpected injuries that are diagnosed with computed tomography (CT) after emergent exploratory laparotomy for trauma and whether identification of such injuries results in additional surgery or angiography. Materials and Methods This HIPAA-compliant retrospective study was approved by the institutional review board, and the requirement for informed consent was waived. The trauma databases of two urban level 1 trauma centers were queried over a period of more than 5 years for patients who underwent abdominopelvic CT within 48 hours of emergent exploratory laparotomy for trauma. Comparisons were made between CT findings and those described in the surgical notes. Descriptive statistics were generated, and 95% confidence intervals (CIs) were determined by using an exact method based on a binomial distribution. Results The study cohort consisted of 90 patients, including both blunt and penetrating trauma victims with a median injury severity score of 17.5 (interquartile range, 9.25-34). Seventy-three percent (66 of 90) of patients sustained penetrating trauma, 82% (74 of 90) of whom were male. A total of 19 patients (21.1%; 95% CI: 13.2, 31.0) had additional injuries within the surgical field that were not identified during laparotomy. There were 17 unidentified solid organ injuries, and eight patients had active bleeding within the surgical field. Eight patients (8.9%; 95% CI: 3.9, 16.8) had unexpected injuries at CT that were substantial enough to warrant additional surgery or angiography. In addition, previously undiagnosed fractures were found in 45 patients (50%; 95% CI: 39.3, 60.7). Conclusion Performing CT after emergent exploratory laparotomy for trauma is useful in identifying unexpected injuries and confirming suspected injuries that were not fully explored at initial surgery. (©) RSNA, 2016.

Endovascular Stenting for Traumatic Common Iliac Pseudoaneurysm as an Adjunct following Exploratory Laparotomy in a Stab Injury Patient

“…Thus, postlaparotomy CT scan is a valuable adjunct to emergency surgery in trauma setting, often depicting unexpected injuries, besides confirming the presence of suspected injuries that were not fully explored at initial surgery. 8 The decision of whether to use open surgical technique or endovascular repair is based on what the surgeon believes is best in that particular scenario. Conventionally, open repair was used in the past for almost all iliac artery aneurysms.…”

Multidetector CT Findings in the Abdomen and Pelvis after Damage Control Surgery for Acute Traumatic Injuries

“…In patients with abdominal trauma who are hemodynamically stable, CT with intravenous contrast material is the imaging modality of choice (17), but the optimal use of imaging in patients undergoing DCS without preoperative imaging is an area of continued study (18)(19)(20)(21)(22)(23). A CT examination performed in the early perioperative period may allow identification of injuries that require additional intervention or occult injuries in or beyond the surgical field and may provide the potential to change the patient treatment plan.…”

“…A CT examination performed in the early perioperative period may allow identification of injuries that require additional intervention or occult injuries in or beyond the surgical field and may provide the potential to change the patient treatment plan. Recent studies have shown that approximately 10%-30% of patients who undergo DCS undergo CT within 48 hours of surgery (19,(21)(22)(23).…”

“…Haste et al (21) reviewed 90 patients who underwent CT after emergency abdominal laparotomy and identified 19 patients with additional injuries within the surgical field that were not described in laparotomy reports. Eight of these patients underwent additional surgery or angiography.…”

“…Exploration of a stable hematoma in the retroperitoneum is avoided to prevent dislodging the clot, with resultant recurrent active hemorrhage. In the cohort of 90 patients imaged within 48 hours of DCS, 17 patients had a nonexpanding retroperitoneal hematoma that was identified but not explored at DCS, with postoperative CT showing renal injuries in 12 patients and an adrenal hematoma identified in two patients (21). If a hematoma appears pulsatile or rapidly expansile, exploration usually results in nephrectomy for renal vascular pedicle injury (57).…”