Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa.
Trauma Surgery Department, Charlotte Maxeke Johannesburg Academic Hospital, 17 Jubilee Road, Parktown, Johannesburg, 2193, South Africa.
World J Surg. 2023 Jun;47(6):1457-1463. doi: 10.1007/s00268-023-06954-1. Epub 2023 Mar 1.
In penetrating abdominal trauma, computed tomography (CT) is routinely performed to evaluate stable patients for selective non-operative management (SNOM). Triple-contrast CT (oral, rectal, and IV) has traditionally been used. However, due to its disadvantages, most trauma centres, including our unit at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), now perform single-contrast intravenous-only CT scans. We performed a retrospective review to determine the accuracy of single-contrast CT scans for detecting hollow viscus injuries (HVI) in penetrating abdominal trauma.
A retrospective review of all patients who presented to CMJAH with penetrating abdominal injuries was performed between 01 August 2017 and 31 August 2019 and were evaluated for SNOM with CT (IV contrast only). Patient records were reviewed to determine pertinent demographics, mechanism, and site of injury, as well as metabolic parameters. CT findings were compared to findings at laparotomy.
A total of 437 patients met the inclusion criteria. The majority were male (92.7%), with a mean age of 31.5 yrs (SD 8.7). Injuries were predominantly due to stab wounds (72,5%, n = 317). CT scan was negative in 342 patients, of which 314 completed SNOM successfully. A total of 93 patients proceeded to laparotomy. CT had a sensitivity of 95.1%, specificity of 44.2%, positive predictive value of 57.4%, and negative predictive value of 92%.
Single-contrast CT in penetrating abdominal trauma is a valuable investigative tool in identifying patients for SNOM. Features of HVI on single-contrast CT are not very specific and should be interpreted along with other clinical factors including wound trajectory and serial abdominal examinations. Other associated injuries such as diaphragmatic and solid organ injuries should be considered in the final management plan.
在穿透性腹部创伤中，为了评估稳定患者是否适合选择性非手术治疗（SNOM），通常会进行计算机断层扫描（CT）检查。传统上使用三联对比 CT（口服、直肠和静脉）。然而，由于其缺点，包括我们所在的夏洛特·马克斯凯 Johannesburg 学术医院（CMJAH）在内的大多数创伤中心现在仅进行单对比静脉 CT 扫描。我们进行了一项回顾性研究，以确定单对比 CT 扫描在检测穿透性腹部创伤中的空腔脏器损伤（HVI）的准确性。
对 2017 年 8 月 1 日至 2019 年 8 月 31 日期间在 CMJAH 就诊的所有穿透性腹部损伤患者进行了回顾性研究，并对 SNOM 进行了 CT（仅静脉对比）评估。对患者记录进行了审查，以确定相关的人口统计学、机制和损伤部位，以及代谢参数。将 CT 发现与剖腹探查结果进行了比较。
共有 437 名患者符合纳入标准。大多数是男性（92.7%，n=317），平均年龄为 31.5 岁（标准差 8.7）。损伤主要由刺伤引起（72.5%，n=317）。342 名患者的 CT 扫描结果为阴性，其中 314 名患者成功完成了 SNOM。共有 93 名患者接受了剖腹手术。CT 的敏感度为 95.1%，特异度为 44.2%，阳性预测值为 57.4%，阴性预测值为 92%。
在穿透性腹部创伤中，单对比 CT 是一种有价值的诊断工具，可以识别适合 SNOM 的患者。单对比 CT 上的 HVI 特征不是很特异，应与其他临床因素（包括伤口轨迹和连续腹部检查）一起解读。在最终的治疗计划中，应考虑其他相关损伤，如膈肌和实质器官损伤。
