Abdominal gunshot wounds: multi-detector-row CT findings compared with laparotomy: a prospective study

The purpose of this study was to access the accuracy of multi-detector-row computed tomography (MDCT) in diagnosing injuries in hemodynamically stable abdominal gunshot wound victims (AGWV). Triple-contrast MDCT was performed in hemodynamically stable AGWV during a 20-month prospective diagnostic accuracy study. Thirty-one patients (30 males, 1 female; mean age, 24.3 years) were evaluated by two radiologists for evidence of injury to solid and hollow organs, vascular structures, urinary bladder, diaphragm, fractures, and general findings (free fluid, pneumoperitoneum, and mesentery lesions). All of the patients underwent laparotomy, and prevalence, sensitivity, specificity, accuracy, and positive and negative predictive values were calculated. No statistically significant differences between radiologists were found. All of the solid and hollow organ lesions, vascular lesions, and general findings were detected. One of the four urinary bladder lesions was missed by MDCT, leading in this case to a sensitivity of 75%, specificity of 100%, positive predictive value of 100%, negative predictive value of 96.4%, and accuracy of 96.8% (p = 0.001). One of the eight diaphragm lesions was missed by MDCT, and its sensitivity was 87.5%, specificity was 100%, positive predictive value was 100%, negative predictive value was 95.8%, and accuracy was 96.8% (p < 0.001). Fractures were diagnosed in 74.4% of the patients (24 of 31). Fourteen (43.2%) patients demonstrated non-therapeutic laparotomy, in which minor lesions could have been managed conservatively. We concluded that MDCT is an accurate imaging method in evaluating selected AGWV, providing trusted information for emergency room physicians.