Document Type : Original Article
Authors
Department of Radio-Diagnosis, Nehru hospital, Postgraduate Institute of Medical Education and Research, Chandigarh , India
Abstract
Objective: Contrast-enhanced computed tomography (CECT) is the investigation of choice in trauma patients. The purpose of this study was to retrospectively evaluate the pattern, severity and association of abdominal injuries based on imaging at a high-volume tertiary trauma care centre. Methods: Retrospective evaluation of the CT records of patients over a period of 5 years was done at our institute. A total of 1519 patients who had undergone contrast-enhanced abdominal CT at a 64-slice Multidetector CT for abdominal trauma were included in this study. Inclusion criteria were: 1) History of blunt abdominal trauma, 2) Patients who had undergone a biphasic CECT abdomen scan. Exclusion criteria were: 1) Patients with penetrating injury, 2) Patients with incomplete data set/records. Results: Liver was the most common injured organ in both adult (38.8%) and paediatric population (40.9%). Significant higher incidence of mesenteric injury, bladder injury, spinal and rib fractures were seen in adult patients. Significant association of anorectal injuries (P=0.003) and bladder/urethral injuries with pelvic fractures was also seen (P <0.001). Conclusion: Our study provided important insights about the pattern, severity and association between the various abdominal injuries based on imaging findings in a large patient population. Larger studies with incorporation of clinical outcome in such patients can help in formulating appropriate management strategies.
Keywords
Main Subjects
- Pinto F, Bode PJ, Tonerini M, Orsitto E. The role of the radiologist in the management of politrauma patients. Eur J
Radiol 2006; 59(3): 315-6. doi: 10.1016/j.ejrad.2006.04.021.
2. Radwan MM, Abu-Zidan FM. Focussed Assessment Sonograph Trauma (FAST) and CT scan in blunt abdominal
trauma: surgeon’s perspective. Afr Health Sci 2006; 6(3): 187-90. doi: 10.5555/afhs.2006.6.3.187.
3. Stengel D, Bauwens K, Sehouli J, Porzsolt F, Rademacher G, Mutze S, et al. Systematic review and meta-analysis
of emergency ultrasonography for blunt abdominal trauma. Br J Surg 2001; 88(7): 901-12. doi: 10.1046/j.0007-
1323.2001.01777.x.
4. Hamilton JD, Kumaravel M, Censullo ML, Cohen AM, Kievlan DS, West OC. Multidetector CT evaluation of
active extravasation in blunt abdominal and pelvic trauma patients. Radiographics 2008; 28(6): 1603-16. doi: 10.1148/rg.286085522.
5. Elton C, Riaz AA, Young N, Schamschula R, Papadopoulos B, Malka V. Accuracy of computed tomography in the
detection of blunt bowel and mesenteric injuries. Br J Surg 2005; 92(8): 1024-8. doi: 10.1002/bjs.4931.
6. Talari H, Moussavi N, Abedzadeh-Kalahroudi M, Atoof F, Abedini A. Correlation between intra-abdominal free fluid and solid organ injury in blunt abdominal trauma. ArchTrauma Res 2015; 4(3): e29184. doi:10.5812/atr.29184.
7. Natarajan B, Gupta PK, Cemaj S, Sorensen M, Hatzoudis GI, Forse RA. FAST scan: is it worth doing in hemodynamically stable blunt trauma patients? Surgery 2010; 148(4): 695-700. doi: 10.1016/j.surg.2010.07.032.
8. Lee BC, Ormsby EL, McGahan JP, Melendres GM, Richards JR. The utility of sonography for the triage of blunt
abdominal trauma patients to exploratory laparotomy. AJR Am J Roentgenol 2007; 188(2): 415-21. doi: 10.2214/
ajr.05.2100.
9. Yasuhara H, Naka S, Kuroda T, Wada N. Blunt thoracic and abdominal vascular trauma and organ injury caused by road traffic accident. Eur J Vasc Endovasc Surg 2000; 20(6):517-22. doi: 10.1053/ejvs.2000.1235.
10. Beaunoyer M, St-Vil D, Lallier M, Blanchard H. Abdominal injuries associated with thoraco-lumbar fractures after motor vehicle collision. J Pediatr Surg 2001; 36(5): 760-2.doi: 10.1053/jpsu.2001.22954.
11. Kwon HM, Kim SH, Hong JS, Choi WJ, Ahn R, Hong ES. Abdominal solid organ injury in trauma patients with
pelvic bone fractures. Ulus Travma Acil Cerrahi Derg 2014; 20(2): 113-9. doi: 10.5505/tjtes.2014.72698.
12. Hamidi MI, Aldaoud KM, Qtaish I. The role of computed tomography in blunt abdominal trauma. Sultan Qaboos Univ Med J 2007; 7(1): 41-6.
13. El Wakeel AM, Habib RM, Ali AN. Role of CT in evaluation of blunt abdominal trauma. Int J Med Imaging 2015; 3(5): 89-93. doi: 10.11648/j.ijmi.20150305.11.
14. Clancy TV, Gary Maxwell J, Covington DL, Brinker CC, Blackman D. A statewide analysis of level I and II trauma
centers for patients with major injuries. J Trauma 2001; 51(2): 346-51. doi: 10.1097/00005373-200108000-00021.
15. Matthes G, Stengel D, Seifert J, Rademacher G, Mutze S, Ekkernkamp A. Blunt liver injuries in polytrauma: results from a cohort study with the regular use of whole-body helical computed tomography. World J Surg 2003; 27(10):1124-30. doi: 10.1007/s00268-003-6981-0.
16. Rabinovici R, Ovadia P, Mathiak G, Abdullah F. Abdominal injuries associated with lumbar spine fractures in blunt trauma. Injury 1999; 30(7): 471-4. doi: 10.1016/s0020-1383(99)00134-5.
17. Demetriades D, Karaiskakis M, Toutouzas K, Alo K, Velmahos G, Chan L. Pelvic fractures: epidemiology and
predictors of associated abdominal injuries and outcomes. J Am Coll Surg 2002; 195(1): 1-10. doi: 10.1016/s1072-
7515(02)01197-3.
18. Metz CM, Hak DJ, Goulet JA, Williams D. Pelvic fracture patterns and their corresponding angiographic sources of hemorrhage. Orthop Clin North Am 2004; 35(4): 431-7.doi: 10.1016/j.ocl.2004.06.002.
19. Cestero RF, Plurad D, Green D, Inaba K, Putty B, Benfield R, et al. Iliac artery injuries and pelvic fractures: a national trauma database analysis of associated injuries and outcomes. J Trauma 2009; 67(4): 715-8. doi: 10.1097/
TA.0b013e3181af6e88.
20. Corwin MT, Sheen L, Kuramoto A, Lamba R, Parthasarathy S, Holmes JF. Utilization of a clinical prediction rule
for abdominal-pelvic CT scans in patients with blunt abdominal trauma. Emerg Radiol 2014; 21(6): 571-6. doi:
10.1007/s10140-014-1233-1.
)