Management of Penetrating Abdominal Trauma in the Conflict Environment: The Role of Computed Tomography Scanning
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Computed tomography (CT) scanning is a vital imaging technique in selecting patients for nonoperative management of civilian penetrating abdominal trauma. This has reduced the rate of nontherapeutic laparotomies and associated complications. Battlefield abdominal injuries conventionally mandate laparotomy, and with the advent of field deployable CT scanners it is unclear whether some ballistic injuries can be managed conservatively.
A retrospective 12 month cohort of patients admitted to a forward surgical facility in Afghanistan who sustained penetrating abdominal injury severe enough to warrant laparotomy or CT scan were studied. Patient details were retrieved from a prospectively maintained operative log and CT logs. Case notes were then reviewed and data pertaining to injury pattern, operative intervention, and survival were collected.
A total of 133 patients were studied: 73 underwent immediate laparotomy (Lap group) and 60 underwent CT scanning (CT group). Of those undergoing CT scanning 17 underwent laparotomy and 43 were selected for nonoperative management. There were 15 deaths in the Lap group and none in the CT group. The median New Injury Severity and Revised Trauma Score was 29 and 7.55 in the Lap group and 9 and 7.8408 in the CT group, which is statistically significantly different (p < 0.001). Five patients in the CT-Lap group had nontherapeutic laparotomies and 1 patient failed nonoperative management.
Computed tomography scanning can be used in stable patients who have sustained penetrating battlefield abdominal injury to exclude peritoneal breach and identify solid abdominal organ injury that can be safely managed nonoperatively.
KeywordsAbdominal Trauma Nonoperative Management Gunshot Wound Revise Trauma Score Solid Organ Injury
The authors are grateful to the personnel of 204 Field Hospital who helped with the identification of patient case notes.
- 9.Mahoney PF, Ryan JM, Brooks AJ et al (2005) Ballistic trauma, 2nd edn. Springer, LondonGoogle Scholar
- 10.O’Reilly DJ, Kilbey J (2007) Analysis of the initial 100 scans from the first CT scanner deployed by the British Armed Forces in a land environment. J R Army Med Corp 153:165–167Google Scholar
- 16.Association for the Advancement of Automotive Medicine, Committee on Injury Scaling (1990) The abbreviated injury scale—1990 revision (AIS-90). Association for the Advancement of Automotive Medicine, Des PlainsGoogle Scholar
- 19.Eastern Association for the Surgery of Trauma, Practice Management Guideline Committee (2010) Practice management guidelines for nonoperative management of penetrating abdominal traumaGoogle Scholar