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Computed Tomography in the Workup of Patients with Penetrating Trauma

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Penetrating Trauma

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Abstract

Penetrating trauma presents one area where operative management has long been considered the gold standard of care. When presented with a patient who has been the victim of a penetrating injury, physiologic status often dictates the need for rapid operative exploration with the goal of control of active hemorrhage and contamination from hollow viscus injuries. Certainly no qualified surgeon, when faced with a victim of penetrating trauma who is hemodynamically unstable with active hemorrhage or evidence of peritonitis, would seriously argue to undertake an extensive radiological workup. However, when faced with the stable patient, there is evolving evidence that information obtained from newer generation computed tomography (CT) scanners, augmented with contrast to allow for CT angiography (CTA), can be valuable in guiding further care and limiting nontherapeutic operative exploration. While historically not typically considered an area of major concern, these nontherapeutic explorations can be a significant source of morbidity and mortality as well as dramatically increasing the length of stay and overall cost. This chapter will examine some of the available evidence with regard to various anatomic locations and provide some guidelines for the appropriate use of CT imaging in the workup of the stable patient with penetrating trauma. Specifically we will examine its use in the workup of penetrating injuries to the abdomen, back and flank, thorax, neck, and extremities.

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Authors and Affiliations

  1. Department of Surgery, Carilion Clinic and Virginia Tech Carilion School of Medicine, 1906 Belleview Ave, Roanoke, 24014, VA, USA

    Mark E. Hamill

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  1. Mark E. Hamill
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Correspondence to Mark E. Hamill .

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Editors and Affiliations

  1. Professor of Surgery Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital Harvard University Medical School, Boston, USA

    George C. Velmahos

  2. Professor Emeritus, Department of Surgery, University of the Witwatersrand Medical School, Milpark Hospital Academic Trauma Centre and Leratong Hospital, Johannesburg, South Africa

    Elias Degiannis

  3. Honorary Senior Lecturer, Department of Surgery, University of the Witwatersrand Medical School, Johannesburg, South Africa

    Dietrich Doll

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Hamill, M.E. (2017). Computed Tomography in the Workup of Patients with Penetrating Trauma. In: Velmahos, G., Degiannis, E., Doll, D. (eds) Penetrating Trauma. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-49859-0_16

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  • DOI: https://doi.org/10.1007/978-3-662-49859-0_16

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