Management of Penetrating Abdominal Trauma in the Conflict Environment: The Role of Computed Tomography Scanning

• Published in: World journal of surgery Vol. 35; no. 1; pp. 27 - 33
• Main Authors: Morrison, Jonathan J., Clasper, Jon C., Gibb, Iain, Midwinter, Mark
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 2011; Springer‐Verlag; Springer; Springer Nature B.V
• Subjects: Abdominal Injuries - diagnostic imaging; Abdominal Injuries - surgery; Abdominal Surgery; Abdominal Trauma; Adolescent; Adult; Afghan Campaign 2001; Aged; Biological and medical sciences; Cardiac Surgery; Child; Child, Preschool; Female; General aspects; General Surgery; Gunshot Wound; Humans; Infant; Injuries of the abdomen. Foreign bodies of the digestive system; Injury Severity Score; Laparotomy; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Nonoperative Management; Patient Selection; Retrospective Studies; Revise Trauma Score; Solid Organ Injury; Surgery; Survival Rate; Thoracic Surgery; Tomography, X-Ray Computed; Traumas. Diseases due to physical agents; Vascular Surgery; Wounds, Penetrating - diagnostic imaging; Wounds, Penetrating - surgery; Gunshot Wound; Revise Trauma Score; Abdominal Trauma; Solid Organ Injury; Nonoperative Management; Abdominal trauma; Scanning; Radiodiagnosis; Penetrating injury; Medicine; Clinical management; Treatment; Conflict; Abdominal disease; Surgery; Medical imagery; Environment; Computerized axial tomography
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-010-0782-z

Background
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.
Methods
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.
Results
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.
Conclusions
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.