[The diagnostic strategy in abdominal trauma]

Diagnosis of a deep visceral lesion in an adult following abdominal contusion is almost always difficult as the abdominal signs are later or masked by associated lesions. All of the controlled studies agree on the superiority of peritoneal puncture-lavage over metrosonography or CT scan in the diagnosis of homeoperitoneu. The diagnostic performance of CT, TDM in the identification of lesions solid organs is very much better that that of ultrasonography. The diagnosis of an isolated lesion of a hallow viscus benefited from progress in imaging to a much lesser degree an peritoneal puncture lavage with leucocyte count remains the key examination. The diagnostic strategy must be based on the patient's clinical condition and on this hierarchy of complementary investigations.