Is computed tomography tractography reliable in patients with anterior abdominal stab wounds?

The current literature and guidelines recommend that determination of peritoneal violation is done first in cases of anterior abdominal stab wounds. The primary endpoint of this study was to determine the reliability of computed tomographic (CT) tractography to assess peritoneal violation in anterior abdominal stab wounds. The secondary endpoint is to compare local wound exploration between conventional CT and CT tractography in the evaluation of peritoneal violation.

A total of 252 patients who were referred with anterior abdominal stab wounds were included in this prospective observational study. Three techniques (local wound exploration, conventional abdominal tomography, and CT tractography) were used to evaluate peritoneal violation. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for each technique to determine peritoneal violation.

The results for the local wound exploration were 100% sensitivity, 100% specificity, 100% PPV, 100% NPV, and 100% accuracy. The results for CT tractography were 95% sensitivity, 100% specificity, 100% PPV, 80% NPV, and 96% accuracy. Conventional abdominal tomography results were 87% sensitivity, 50% specificity, 91% PPV, 40% NPV, and 82% accuracy.

Local wound exploration is 100% effective in determining peritoneal violation with anterior abdominal stab wounds. CT tractography is better than conventional CT in detecting peritoneal violation. However, we do not recommend CT tractography in anterior abdominal stab wounds due to the false-negative results.