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

Alabousi, Mostafa; Zha, Nanxi; Patlas, Michael N.

doi:10.2214/ajr.20.24636

Cited by 13 publications

(4 citation statements)

References 36 publications

(88 reference statements)

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“…Other concerns include the risk of aspiration, especially in patients who will proceed to laparotomy [ 4 , 21 ]. In addition, recent studies found that triple-contrast CT has a sensitivity equal to that of single-contrast CT in detecting HVI and that the addition of enteric contrast did not provide any diagnostic benefit [ 4 , 14 , 15 ]. As a result, most trauma centres, including the unit at CMJAH, have adopted single-contrast CT as the standard modality [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, it has been shown that there is no diagnostic benefit in the addition of enteric contrast for detecting HVI compared to an IV contrast-only CT. In the trauma setting, single-contrast CT is often performed, as triple-contrast CT results in delayed diagnosis and surgical intervention due to the time required for enteric opacification [ 4 , 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Accuracy of CT Scan for Detecting Hollow Viscus Injury in Penetrating Abdominal Trauma

2023

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Background In penetrating abdominal trauma, computed tomography (CT) is routinely performed to evaluate stable patients for selective non-operative management (SNOM). Triple-contrast CT (oral, rectal, and IV) has traditionally been used. However, due to its disadvantages, most trauma centres, including our unit at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), now perform single-contrast intravenous-only CT scans. We performed a retrospective review to determine the accuracy of single-contrast CT scans for detecting hollow viscus injuries (HVI) in penetrating abdominal trauma. Methods A retrospective review of all patients who presented to CMJAH with penetrating abdominal injuries was performed between 01 August 2017 and 31 August 2019 and were evaluated for SNOM with CT (IV contrast only). Patient records were reviewed to determine pertinent demographics, mechanism, and site of injury, as well as metabolic parameters. CT findings were compared to findings at laparotomy. Results A total of 437 patients met the inclusion criteria. The majority were male (92.7%), with a mean age of 31.5 yrs (SD 8.7). Injuries were predominantly due to stab wounds (72,5%, n = 317). CT scan was negative in 342 patients, of which 314 completed SNOM successfully. A total of 93 patients proceeded to laparotomy. CT had a sensitivity of 95.1%, specificity of 44.2%, positive predictive value of 57.4%, and negative predictive value of 92%. Conclusion Single-contrast CT in penetrating abdominal trauma is a valuable investigative tool in identifying patients for SNOM. Features of HVI on single-contrast CT are not very specific and should be interpreted along with other clinical factors including wound trajectory and serial abdominal examinations. Other associated injuries such as diaphragmatic and solid organ injuries should be considered in the final management plan.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Accuracy of CT Scan for Detecting Hollow Viscus Injury in Penetrating Abdominal Trauma

2023

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“…Enteric (oral and/or rectal) contrast media are currently not recommended for the first CT in blunt abdominal trauma and are not routinely used in penetrating trauma. The results of a recent meta-analysis [ 19 ] did not support the use of enteric contrast media in penetrating trauma, and this position has been endorsed by the World Society of Emergency Surgery (WSES) [ 1 ], which cited the lack of improved accuracy, delayed examination time, increased cost, and potential surgical delay due to aspiration risk. However, local experience, surgeon preference, and new evidence [ 20 ] keep the debate open and the topic undecided.…”

Section: Imaging Evaluationmentioning

confidence: 99%

Radiologic Imaging of Traumatic Bowel and Mesenteric Injuries: A Comprehensive Up-to-Date Review

et al. 2023

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Diagnosing bowel and mesenteric trauma poses a significant challenge to radiologists. Although these injuries are relatively rare, immediate laparotomy may be indicated when they occur. Delayed diagnosis and treatment are associated with increased morbidity and mortality; therefore, timely and accurate management is essential. Additionally, employing strategies to differentiate between major injuries requiring surgical intervention and minor injuries considered manageable via non-operative management is important. Bowel and mesenteric injuries are among the most frequently overlooked injuries on trauma abdominal computed tomography (CT), with up to 40% of confirmed surgical bowel and mesenteric injuries not reported prior to operative treatment. This high percentage of falsely negative preoperative diagnoses may be due to several factors, including the relative rarity of these injuries, subtle and non-specific appearances on CT, and limited awareness of the injuries among radiologists. To improve the awareness and diagnosis of bowel and mesenteric injuries, this article provides an overview of the injuries most often encountered, imaging evaluation, CT appearances, and diagnostic pearls and pitfalls. Enhanced diagnostic imaging awareness will improve the preoperative diagnostic yield, which will save time, money, and lives.

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“…1 A meta-analysis of 12 studies and 1287 subjects found that enteric contrast adds no additional diagnostic benefit when compared with the use of IV contrast material alone. 2 A study on a single emergency department's visits between the years of 2004 and 2014 found that CT with IV contrast alone had a sensitivity of 88% and specificity of 72% in detecting bowel injuries in the setting of penetrating abdominopelvic trauma, while past studies on CT with IV, oral and rectal contrast have shown sensitivities of 67-100% and specificities of 80-97%. 3 While the utility of rectal contrast alone lacks substantial research, Thorisdottir et al found that CT with gastrointestinal contrast had similar sensitivity as CT with IV contrast only, based on analysis of over 600 patients with penetrating abdominal trauma.…”

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confidence: 99%

Intravenous Versus Rectal Contrast in CT Imaging for Abdominal Gunshot Wounds

Rendel

Hepner

Reese

et al. 2023

The American Surgeon™

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CT imaging with rectal contrast historically has been a useful tool to help identify potential colon/rectal injuries; however, recent trends have shown less utilization of rectal contrast, in favor of IV contrast CT imaging alone. A retrospective review of patients with abdominal gunshot wounds was carried out to compare the two CT imaging techniques. An analysis of patients with colorectal injuries was conducted. Patients with IV contrast had a sensitivity of 84% and specificity of 96.8%. The PPV was 87.5% and NPV was 95.8%. In the IV and rectal contrast group, the sensitivity was 88.9% and specificity was 90.5%. The PPV was 80% and NPV was 95%. The proportion of missed injuries between the two was not statistically significant, p=0.18. The study suggests that while CT imaging with rectal contrast confidently identifies colon/rectal injuries, there are often secondary findings that will correctly prompt surgical exploration.

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

Cited by 13 publications

References 36 publications

Accuracy of CT Scan for Detecting Hollow Viscus Injury in Penetrating Abdominal Trauma

Accuracy of CT Scan for Detecting Hollow Viscus Injury in Penetrating Abdominal Trauma

Radiologic Imaging of Traumatic Bowel and Mesenteric Injuries: A Comprehensive Up-to-Date Review

Intravenous Versus Rectal Contrast in CT Imaging for Abdominal Gunshot Wounds

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