Determining the need for laparotomy in penetrating torso XXXX : a prospective study using triple-contrast enhanced abdominopelvic computed tomography.

@entity1 @entity18329 @entity1661 @entity2980 @entity99 @entity130
BACKGROUND: The nontherapeutic laparotomy rate in penetrating @entity1661 remains high and the morbidity rate in these cases is approximately 40%. Selective management, rather than mandatory laparotomy, has become a popular approach in both @entity2980 and @entity18329 . The advent of spiral technology has stimulated a reassessment of the role of computed tomography (CT) in many aspects of @entity130 care. We prospectively investigated the current utility of triple-contrast CT as a diagnostic tool to facilitate initial therapeutic management decisions in penetrating torso @entity130 . METHODS: We studied hemodynamically stable @entity1 with penetrating injury to the torso (abdomen, pelvis, flank, back, or lower chest) without definite indication for laparotomy, admitted to our @entity130 center during the 1-year period from 7/99 through 6/00. @entity1 underwent triple-contrast enhanced spiral CT as the initial study. A positive CT scan was defined as any evidence of peritoneal violation (free air or fluid, contrast leak, or @entity130 ). @entity1 with positive CT, except those with isolated solid viscus injury, underwent laparotomy. @entity1 with negative CT were observed. RESULTS: There were 75 consecutive @entity1 studied: mean age 30 years (range 15-85 years); 67 (89%) male; 41 (55%) gunshot wound, 32 (43%) stab wound, 2 (3%) shotgun wound; mean admission systolic blood pressure 141 mm Hg (range 95-194 mm Hg); 26 (35%) had positive CT and 49 (65%) had negative CT. In @entity1 with positive CT, 18 (69%) had laparotomy: 15 therapeutic, 2 nontherapeutic, and 1 negative. Five @entity1 had isolated @entity99 and 2 had hepatic and @entity130 on CT and all were successfully managed without laparotomy. Of these seven @entity1 , three had angioembolization and two had thoracoscopic diaphragm repair. In @entity1 with negative CT, 47/49 (96%) had successful nonoperative management and 1 had negative laparotomy. The single CT-missed peritoneal violation had a @entity130 at laparotomy. CT accurately predicted whether laparotomy was needed in 71/75 (95%) @entity1 . CONCLUSION: In penetrating torso @entity130 , triple-contrast abdominopelvic CT can accurately predict need for laparotomy, exclude peritoneal violation, and facilitate nonoperative management of @entity99 . Adjunctive angiography and investigation for @entity130 may be prudent.
