Triple-contrast helical CT in penetrating torso XXXX : a prospective study to determine peritoneal violation and the need for laparotomy.

@entity1 @entity1049 @entity99 @entity130
OBJECTIVE: A prospective study was performed to determine the usefulness of triple-contrast helical CT in predicting peritoneal violation and the need for laparotomy in the treatment of penetrating torso @entity130 . SUBJECTS AND METHODS: Triple-contrast helical CT scans were obtained in 104 hemodynamically stable @entity1 with penetrating injuries to the torso (thoracoabdominal region including tangential wounds to the anterior abdomen, flank, back, and pelvis) over a 17-month period. The study group included 54 @entity1 with gunshot wounds and 50 with stab wounds. No @entity1 had a radiographic or clinical indication for immediate laparotomy. A positive finding on CT was defined as evidence of peritoneal violation or @entity1049 , major vessel, or urinary tract. @entity1 with a positive CT, except @entity1 with isolated @entity99 or free fluid, underwent laparotomy. @entity1 with a negative finding on CT were initially observed. RESULTS: CT studies were positive in 35 (34%) of 104 @entity1 and negative in 69 (66%) of 104 of @entity1 . Laparotomy was performed in 21 (60%) of 35 @entity1 with positive CT; 19 (86%) of 22 were therapeutic, two (9%) were nontherapeutic, and one (5%) was negative (no injury was found). Nine @entity1 with isolated @entity99 were successfully treated without laparotomy. Among @entity1 with a negative CT, 67 (97%) of 69 were treated nonoperatively with success. CT had 100% (19/19) sensitivity, 96% (69/72) specificity, 100% (69/69) negative predictive value, and 97% (101/104) accuracy in predicting the need for laparotomy. CONCLUSION: Triple-contrast helical CT can accurately predict the need for laparotomy and exclude peritoneal violation in penetrating torso @entity130 including tangential abdominal wounds.
