CT-guided tractography is a safe and complementary diagnostic tool in the management of penetrating abdominal trauma

Akkoca, Muzaffer; Balas, Şener; Yılmaz, Kerim Bora; Tatar, İdil Güneş; Akıncı, Melih; Tokgöz, Serhat; Tamam, Selim; Karabacak, Harun

doi:10.1016/j.asjsur.2018.05.007

Cited by 10 publications

(8 citation statements)

References 17 publications

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“…Multiple studies have established the accuracy of CECT in identifying peritoneal breach and intraabdominal injury in penetrating abdominal trauma [ 12 , 16 ]. Addition of tractography was found to have high specificity and sensitivity, but negative predictive value remained low [ 17 , 18 ]. Thorisdottir et al reported that CT could identify hollow viscus injury in 76% patients.…”

Section: Discussionmentioning

confidence: 99%

Contrast-enhanced computed tomography abdomen versus diagnostic laparoscopy-based management in patients with penetrating abdominal trauma: a randomised controlled trial

Kaur

Bagaria

Kumar

et al. 2022

Eur J Trauma Emerg Surg

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Purpose Penetrating abdominal trauma was traditionally managed by mandatory exploration, which led to high rates of non-therapeutic surgery and prolonged hospital stay. Diagnostic laparoscopy (DL) is a less-invasive alternative; however, it requires general anaesthesia and carries a potential risk of iatrogenic injuries. Contrast-enhanced computed tomography (CECT)-guided selective non-operative management (SNOM) may avoid surgery altogether, but there is apprehension of missed injury. Randomised trials comparing these two modalities are lacking. This study is aimed at comparing outcomes of these two management approaches. Methods Hemodynamically stable patients with penetrating trauma to anterior abdominal wall were randomised in 1:1 ratio to DL or CECT-based management. Primary outcome was length of hospital stay (LOS). Secondary outcomes were rate of non-therapeutic surgery, complications, and length of intensive care unit (ICU) stay. Results There were 52 patients in DL group and 54 patients in CECT group. Mean LOS was comparable (3 vs 3.5 days; p = 0.423). Rate of non-therapeutic surgery was significantly lower in CECT group (65.4 vs 17.4%, p = 0.0001). Rate of complications and length of ICU stay were similar. Selective non-operative management based on CECT findings was successful in 93.8% of patients; 2 patients had delayed surgery. Conclusion In patients with penetrating trauma to anterior abdominal wall, DL and CECT-based management led to comparable hospital stay. Significant reduction in non-therapeutic surgery could be achieved using a CECT-based approach. Trial registration Clinical trials registry-India (CTRI/2019/04/018721, REF/2019/01/023400).

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Section: Discussionmentioning

confidence: 99%

Contrast-enhanced computed tomography abdomen versus diagnostic laparoscopy-based management in patients with penetrating abdominal trauma: a randomised controlled trial

Kaur

Bagaria

Kumar

et al. 2022

Eur J Trauma Emerg Surg

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“…There are a lot of algorithms for management of the hemodynamically stable patient with penetrating anterior abdominal wall injuries [9]. While some rely on serial clinical examinations, others use investigations such as local wound exploration and diagnostic laparoscopy in identifying patients with penetrating wounds and deciding their further management [10]. In stable patients with penetrating wounds, LWE has been used to rule out anterior fascia penetration; if this test is negative, patients may be safely released from the emergency room [11].…”

Section: Discussionmentioning

confidence: 99%

CT Tractography as a last option for penetrating abdominal wall injuries with equivocal contrast CT findings: A proposed diagnostic approach

Ewedah

Bassiony

Asal

2022

Preprint

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Background CT tractography is a potential approach in which a CT is conducted after an entire stab wound tract is filled with a water-soluble contrast agent in patients with abdominal stab wounds. The goal of this study is to evaluate the effectiveness of using CT tractography as an option in the management of penetrating abdominal trauma. Does CT Tractography function as a useful technique for assessing patients with Anterior Abdominal Stab Wounds (AASW)? Patients and Methods The study included 82 patients admitted to the trauma center at Alexandria Main University Hospital in Egypt who had penetrating anterior abdominal wall injuries, were in stable condition, and had a contrast CT scan of the abdomen and pelvis that was inconclusive about peritoneal penetration. Results A total of 57 patients underwent exploration after showing positive findings of contrast leak into the peritoneal cavity. 25 patients with CT Tractography results that demonstrated no leak into the peritoneal cavity were treated conservatively without the necessity for surgical intervention. Conclusion In the study, CT tractography correctly identified 100% of the patients who needed laparotomies, and none of the patients without peritoneal penetration required surgical intervention during follow-up. The examination of patients with AASW can be done efficiently by CT tractography.

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“…Обсуждение Согласно многочисленным зарубежным публикациям, активно-выжидательная тактика -это безопасный и эффективный метод у гемодинамически стабильных пациентов без инструментальных и без клинических признаков повреждения органов брюшной полости и перитонита [1,2,3,4,7,8]. Диагностические лапаротомии, при которых повреждений внутренних органов выявлено не было, составляют на сегодняшний день в среднем, по разным данным, от 23 до 45 % [9,10].…”

Section: результатыunclassified

“…Инвалидизация при выполнении эксплоративных лапаротомий по разным данным колеблется в пределах от 2,5 до 13 % [5,11]. А уровень смертности остается на уровне 0,1 -3,5 % [1,5,9,12]. В нашем исследовании летальность составила 1,04%.…”

Section: результатыunclassified

Selective Nonoperative Management of Penetrating Abdominal Stab Wounds: Retrospective Cohort Study

Rogal

Yartsev²,

Stinskaya³

2022

jour

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Introduction: in modern conditions, the number of patients with penetrating abdominal wounds remains high. At present, in urgent surgical practice, the problem of developing a unified algorithm for the diagnosis and treatment of hemodynamically stable patients with penetrating abdominal stab wounds in order to reduce the number of «unnecessary» laparotomies/laparoscopies remains relevant.Aim: improving the effectiveness of management of patients with penetrating stab wounds of the abdomen w, the creation and implementation of the Level I trauma centers of the nonoperative algorithm for this category of patients.Materials and methods: a cohort retrospective study for the period from 2018 to 2021 included hemodynamically stable patients with penetrating stab wounds of the abdomen, who were treated at the N.V. Sklifosovsky, to which various surgical tactics were applied. Over a 3-year period, 96 patients were selected, of which 72.9% were men and 27.1% were women. The mean age was 33.6 ± 6.5 years. 34 (35.4%) patients were treated conservatively, exploratory laparotomy was performed in 22 (22.9%) patients, exploratory laparoscopy was performed in 40 (41.7%) patients. Results: the analysis of the data obtained during the study revealed a significant decrease in the number of intra- and postoperative complications, a decrease in the duration of hospital stay by using selective non operative management in hemodynamically stable patients.Conclusion: a selective conservatism in hemodynamically stable patients are effective and allow avoiding «unnecessary» surgical interventions, reducing the level of disability and mortality.

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CT-guided tractography is a safe and complementary diagnostic tool in the management of penetrating abdominal trauma

Cited by 10 publications

References 17 publications

Contrast-enhanced computed tomography abdomen versus diagnostic laparoscopy-based management in patients with penetrating abdominal trauma: a randomised controlled trial

Contrast-enhanced computed tomography abdomen versus diagnostic laparoscopy-based management in patients with penetrating abdominal trauma: a randomised controlled trial

CT Tractography as a last option for penetrating abdominal wall injuries with equivocal contrast CT findings: A proposed diagnostic approach

Selective Nonoperative Management of Penetrating Abdominal Stab Wounds: Retrospective Cohort Study

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