Skip to main content
Log in

Blunt abdominal trauma: Computed tomography, ultrasound, or diagnostic peritoneal lavage: When and by whom?

  • Review Article
  • Published:
Emergency Radiology Aims and scope Submit manuscript

Abstract

The most important imaging decision that the clinician must make regarding the patient who sustains blunt abdominal trauma (BAT) is whether the patient is stable enough to undergo computed tomography (CT). CT is the most sensitive and specific examination for the evaluation of BAT. If the patient is unstable, the clinician has three choices: surgery, diagnostic peritoneal lavage, or ultrasound (US). If the patient then stabilizes, a CT scan should be obtained even if the US is negative.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Mirvis SE, Gens DR, Shanmuganathan K. Rupture of the bowel after blunt abdominal trauma: diagnosis with CT. AJR Am J Roentgenol 1992;159:1217–21.

    CAS  PubMed  Google Scholar 

  2. Ngheim HV, Jeffrey RB Jr, Mindelzun RE. CT of blunt trauma to the bowel and mesentery. AJR Am J Roentgenol 1993;160:53–8.

    Google Scholar 

  3. Wolfman NT, Bechtold RE, Scharling ES, Meredith JW. Blunt upper abdominal trauma: evaluation by CT. AJR Am J Roentgenol 1992;158:493–501.

    CAS  PubMed  Google Scholar 

  4. Shanmuganathan K, Mirvis SE, Sover ER. Value of contrast-enhanced CT in detecting active hemorrhage in patients with blunt abdominal or pelvic trauma. AJR Am J Roentgenol 1993;161:65–9.

    CAS  PubMed  Google Scholar 

  5. Boulanger BR, Brenneman FD, McLellan BA, Rizoli SB, Culhane J, Hamilton P. A prospective study of emergent abdominal sonography after blunt trauma. J Trauma 1995;39:325–30.

    Article  CAS  PubMed  Google Scholar 

  6. Buzzas GR, Kern SJ, Smith R, et al. A comparison of sonographic examinations for trauma performed by surgeons and radiologists. J Trauma 1998;44:604–8.

    CAS  PubMed  Google Scholar 

  7. Ma J, Mateer JR, Ogata M, Kefer MP, Wittmann D, Aprahamian C. Prospective analysis of a rapid trauma ultrasound examination performed by emergency physicians. J Trauma 1995;38:879–85.

    CAS  PubMed  Google Scholar 

  8. McKenney M, Lentz K, Nuñez D, et al. Can ultrasound replace diagnostic peritoneal lavage in the assessment of blunt trauma? J Trauma 1994;37:439–41.

    CAS  PubMed  Google Scholar 

  9. McKenney MG, Martin L, Lentz K, et al. 1000 consecutive ultrasounds for blunt abdominal trauma. J Trauma 1996;40:607–12.

    Article  CAS  PubMed  Google Scholar 

  10. Rozycki GS, Ochsner MG, Jaffin JH, Champion HR. Prospective evaluation of surgeons’ use of ultrasound in the evaluation of trauma patients. J Trauma 1993;34:516–27.

    CAS  PubMed  Google Scholar 

  11. Rozycki GS, Ochsner MG, Schmidt JA, et al. A prospective study of surgeon-performed ultrasound as the primary adjuvant modality for injured patient assessment. J Trauma 1995;39:492–8.

    CAS  PubMed  Google Scholar 

  12. Rozycki GS, Shackford SR. Ultrasound: what every trauma surgeon should know. J Trauma 1996;40:1–4.

    CAS  PubMed  Google Scholar 

  13. McKenney KL, Nuñez DB, McKenney MG, et al. Sonography as the primary screening technique for blunt abdominal trauma: experience with 899 patients. AJR Am J Roentgenol 1998;170:979–85.

    CAS  PubMed  Google Scholar 

  14. American Institute of Ultrasound in Medicine. Training guidelines for physicians who evaluate and interpret diagnostic ultrasound examinations. Rockville, MD: American Institute of Ultrasound in Medicine, 1993.

    Google Scholar 

  15. Tso P, Rodriguez A, Cooper C, et al. Sonography in blunt abdominal trauma: a preliminary progress report. J Trauma 1992;33:39–44.

    CAS  PubMed  Google Scholar 

  16. Sherbourne CD, Shanmuganathan K, Mirvis SE, et al. Visceral injury without hemoperitoneum: a limitation of screening abdominal sonography for trauma. Emerg Radiol 1997;4:349–54.

    Article  Google Scholar 

  17. Chiu WC, Cushing BM, Rodriguez A, et al. Abdominal injuries without hemoperitoneum: a potential limitation of focused abdominal sonography for trauma (FAST). J Trauma 1997;4:617–25.

    Article  Google Scholar 

  18. Healy MA, Simons RK, Winchell RJ, et al. A prospective evaluation of abdominal ultrasound in blunt trauma: is it useful? J Trauma 1996;6:875–85.

    Article  Google Scholar 

  19. Boulanger BR, McLellan BA, Brenneman FD, et al. Emergent abdominal sonography as a screening test in a new diagnostic algorithm for blunt trauma. J Trauma 1996;6:867–74.

    Google Scholar 

  20. Bell C, Coleridge ST. A comparison of diagnostic peritoneal lavage and computed tomography (CT scan) in evaluation of the hemodynamically stable patient with blunt abdominal trauma. J Emerg Med 1992;10:275–80.

    Article  CAS  PubMed  Google Scholar 

  21. Bilge A, Sahin M. Diagnostic peritoneal lavage in blunt abdominal trauma. Eur J Surg 1991;157:449–51.

    CAS  PubMed  Google Scholar 

  22. Freyer JP, Graham TL, Fong HM, Burns CM. Diagnostic peritoneal lavage as an indicator for therapeutic surgery. Can J Surg 1991;34:471–6.

    Google Scholar 

  23. Meredith JW, Ditesheim JA, Stonehouse S, Wolfman N. Computed tomography and diagnostic peritoneal lavage: complementary roles in blunt trauma. Am Surg 1992;58:44–8.

    CAS  PubMed  Google Scholar 

  24. Meyer DM, Thal ER, Weigelt JA, Redman HC. Evaluation of computed tomography and diagnostic peritoneal lavage in blunt abdominal trauma. J Trauma 1989;29:1168–72.

    Article  CAS  PubMed  Google Scholar 

  25. Wherrett LJ, Boulanger BR, McLellan BA, et al. Hypotension after blunt abdominal trauma: the role of emergent abdominal sonography in surgical triage. J Trauma 1996;41:815–20.

    CAS  PubMed  Google Scholar 

  26. Roszler MH, Saxe J, McCarroll KA. Detection of free intraperitoneal air on CT after blunt abdominal trauma. Emerg Radiol 1995;2:84–9.

    Article  Google Scholar 

  27. American College of Radiology. Appropriateness criteria: blunt abdominal trauma variant 2 GI-4.2. Reston, VA: American College of Radiology, 1997.

    Google Scholar 

  28. Feliciano DV. Diagnostic modalities in abdominal trauma. Surg clin North Am 1991;71:241–56.

    CAS  PubMed  Google Scholar 

  29. Jehle D, Guarino J, Karamanoukian H. Emergency department ultrasound in the evaluation of blunt trauma. Am J Emerg Med 1993;11:342–6.

    Article  CAS  PubMed  Google Scholar 

  30. American College of Radiology, Appropriateness criteria: blunt abdominal trauma variant 1 GI-4.1. Reston, VA: American College of Radiology, 1997.

    Google Scholar 

  31. Cook DE, et al. Upper abdominal trauma: pitfalls in CT diagnosis. Radiology 1986;159:65–9.

    CAS  PubMed  Google Scholar 

  32. Halvorsen RA, McCormick VD, Evans SJ. Computed tomography of abdominal trauma: a step by step approach. Emerg Radiol 1994;1:283–91.

    Article  Google Scholar 

  33. Nuñez D Jr, Webster JD, Lentz KA, Amenodola MA. Helical CT of liver injuries: a trial of dual phase imaging. Emerg Radiol 1996;3:20–4.

    Article  Google Scholar 

  34. Wolfman NT, Bechtold RE, Scharling ES, Meredith JW. Blunt upper abdominal trauma: evaluation by CT. AJR Am J Roentgenol 1992;158:493–501.

    CAS  PubMed  Google Scholar 

  35. Rizzo MJ, Federle MP, Griffiths BG. Bowel and mesenteric injury following blunt abdominal trauma: evaluation with CT. Radiology 1989;173:143–8.

    CAS  PubMed  Google Scholar 

  36. Bulas DI, Taylor GA, Eichelberger MR. The value of CT in detecting bowel perforation in children after blunt abdominal trauma. AJR Am J Roentgenol 1989;153:561–4.

    CAS  PubMed  Google Scholar 

  37. Casey L, Vu D, Cohen AJ. Small bowel rupture after blunt trauma: computed tomographic signs and their sensitivity. Emerg Radiol 1995;2:90–5.

    Article  Google Scholar 

  38. Kearney PA Jr, Vahey T, Burney RE, Glazer G. Computed tomography and diagnostic peritoneal lavage in blunt abdominal trauma: their combined role. Arch Surg 1989;124:344–7.

    PubMed  Google Scholar 

  39. Sherck JP, Oakes DD. Intestinal injuries missed by computed tomography. J Trauma 1990;30:1–7.

    CAS  PubMed  Google Scholar 

  40. DeMaria EJ. Management of patients with indeterminate diagnostic peritoneal lavage results following blunt trauma. J Trauma 1991;31:1627–31.

    CAS  PubMed  Google Scholar 

  41. Becker CD, Spring P, Glattli A, Schweizer W. Blunt splenic trauma in adults: can CT findings be used to determine the need for surgery? AJR Am J Roentgenol 1994;162:343–7.

    CAS  PubMed  Google Scholar 

  42. Croce MA, Fabian TC, Menke PG, et al. Nonoperative management of blunt hepatic trauma is the treatment of choice for hemodynamically stable patients: results of a prospective trial. Ann Surg 1995;221:744–55.

    Article  CAS  PubMed  Google Scholar 

  43. Pachter HL, Knudson MM, Esrig B, et al. Status of nonoperative management of blunt hepatic injuries: a multicenter experience with 404 patients. J Trauma 1996;40:31–8.

    CAS  PubMed  Google Scholar 

  44. Smith RS, Kern SJ, Fry WR, et al. Institutional learning curve of surgeon-performed trauma US. Arch Surg 1998;133:530–6.

    Article  CAS  PubMed  Google Scholar 

  45. American College of Radiology. Summary of literature review in imaging of blunt abdominal trauma American College of Radiology appropriateness criteria GI-4.4-GI-4.9. Reston, VA: American College of Radiology, 1996.

    Google Scholar 

  46. Visvanathan R, Low HC. Blunt abdominal trauma: injury assessment in relation to early surgery. J R Coll Surg Edinb 1993;39:19–22.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Roszler, M.H. Blunt abdominal trauma: Computed tomography, ultrasound, or diagnostic peritoneal lavage: When and by whom?. Emergency Radiology 5, 403–409 (1998). https://doi.org/10.1007/BF02749188

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02749188

Key Words

Navigation