Role of ultrasonography, computed tomography and diagnostic peritoneal lavage in abdominal blunt trauma

OBJECTIVE: To compare the diagnostic accuracy of diagnostic peritoneal lavage (DPL), ultrasonography and computed tomography in the management of blunt abdominal trauma.

METHODS: A retrospective review of the charts of 233 patients with blunt abdominal trauma necessitating admission to Riyadh Medical Complex, Riyadh, Kingdom of Saudi Arabia was carried out over a 2 year period (January 2000 to December 2001). The diagnostic yields of DPL, ultrasound and computed tomography were analyzed. The results were compared with findings on subsequent laparotomy or ultimate outcome, which continued in hospital observation and conservative management.

RESULTS: Mean age was 23 years and 79% patients were male. Road traffic accident remained the most common cause (70%) and 56% patients had multisystem injuries. The sensitivity for DPL, ultrasound and computed tomography scans was found to be 98%, 96% and 98% with an overall accuracy rate of 92%, 95% and 99%. Diagnostic peritoneal lavage showed false positive results with retroperitoneal injuries and missed one small bowel injury and a pancreatic injury, and resulted in one catheter related bowel injury. Computed tomography scan was able to grade, quantify and localize the injury and helped in devising a successful management plan in 76.5% cases.

CONCLUSION: Diagnostic peritoneal lavage is a promising bedside investigation, but is invasive with low accuracy for retroperitoneal injuries and high probability of nontherapeutic laparotomy with false positive results. The high sensitivity and accuracy rates of computed tomography justify its use in quantifying and estimating the grade of injury in order to select the appropriate management of trauma victims. Computed tomography is recommended as the initial investigation of choice in hemodynamically stable patients with blunt abdominal trauma.