Diagnostic performance of CT and the use of GI contrast material for detection of hollow viscus injury after penetrating abdominal trauma. Experience from a level 1 Nordic trauma center

Abstract

Background Use of gastrointestinal (GI) contrast material for computed tomography (CT) diagnosis of hollow viscus injury (HVI) after penetrating abdominal trauma is still controversial. Purpose To assess the sensitivity of CT and GI contrast material use in detecting HVI after penetrating abdominal trauma. Material and Methods Retrospective analysis (2013–2016) of patients with penetrating abdominal trauma. Data from the local trauma registry, medical records, and imaging from PACS were reviewed. CT and surgical findings were compared. Results Of 636 patients with penetrating trauma, 177 (163 men, 14 women) had abdominal trauma (mean age 34 years, age range 16–88 years): 155/177 (85%) were imaged with CT on arrival; 128/155 (83%) were stab wounds and 21/155 (14%) were gunshot wounds; 47/155 (30%) had emergent surgery after CT. Two patients were imaged using oral, rectal and i.v. contrast; 23 with rectal and i.v. contrast; and 22 with i.v. contrast only. Surgery revealed HVI in 26 patients. CT had an overall sensitivity 69.2%, specificity 90.5%, PPV 90.0%, and NPV 70.4%. CT with oral and/or rectal contrast (n = 25) had sensitivity 66.7%, specificity 71.4%, PPV 85.7%, and NPV 45.5%. CT with i.v. contrast only (n = 22) had 75% sensitivity, 100% specificity, PPV 100%, and NPV 87.5%. No statistically significant difference was found between sensitivity of CT with GI contrast material and i.v. contrast only ( P = 1). Conclusion Stab wounds were the most common cause of penetrating abdominal trauma. CT had 69.2% sensitivity and 90.5% specificity in detecting HVI. CT with GI contrast had similar sensitivity as CT with i.v. contrast only.

Use of Enteric Contrast Material for Abdominopelvic CT in Penetrating Traumatic Injury in Adults: Comparison of Diagnostic Accuracy Systematic Review and Meta-Analysis

“…The assessment of agreement between the two investigators in the initial screen of 50 studies demonstrated Cohen's kappa of 0.81. Ultimately, 12 studies published between 2004 and 2020 with a total of 1,287 patients with penetrating abdominopelvic injury (389 with confirmed bowel, mesenteric, or other abdominopelvic injury) were included (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). Two studies had been excluded due to overlapping patient samples (33,34) with an included study (21).…”

“…Two studies had been excluded due to overlapping patient samples (33,34) with an included study (21). The enteric contrast group included seven studies reporting on 506 patients with penetrating injury (124 with confirmed bowel, mesenteric, or other abdominopelvic organ injury) (21,22,24,27,29,30,32), while the nonenteric contrast group included six studies reporting on 781 patients with penetrating injury (265 with confirmed bowel, mesenteric, or other abdominopelvic organ injury) (23,25,26,28,31,32).…”

“…Only one study directly compared the use of enteric contrast with the use of IV contrast alone, reporting on 47 patients with penetrating injury (26 with confirmed bowel, mesenteric, or other abdominopelvic organ injury) in total (32). A summary of characteristics for the included studies is provided in Table 1, and a summary of imaging characteristics and findings for each included study is provided in Table 2.…”

“…mesenteric injury alone (22)(23)(24)(26)(27)(28)(29)31,32), while the remaining three studies reported on the presence of any traumatic abdominopelvic injury (21,25,30). All included studies were conducted at a single center.…”

“…The mean or median patient age across the studies ranged from 24 to 44 years. With respect to mechanism of injury, four studies only included stab wounds (23,24,26,30), two studies only included gunshot wounds (22,27), while the remaining six studies included any type of penetrating injury (21,25,28,29,31,32). Only four studies reported funding status (24,29,30,32).…”