CT scan in blunt abdominal trauma

CT scan has been used in blunt abdominal trauma with increasing popularity during the last decade. The sensitivity, specificity and accuracy of CT scan in blunt abdominal trauma have been reported to be very high. CT scan has been shown to eliminate the disadvantages of diagnostic peritoneal lavage (DPL) in the diagnosis of retroperitoneal organ injuries and when there are associated major pelvic fractures. This study describes the results of CT scan in 50 blunt abdominal trauma patients at the Chulalongkorn Hospital, Bangkok, Thailand. All patients had stable vital signs at the time of CT scanning although 36 per cent were in shock on arrival. In all, 34 per cent had associated pelvic fractures. Retroperitoneal organ injuries were suspected in 80 per cent. Of the patients, 34 per cent underwent exploratory laparotomies because of positive CT scan with three unnecessary operations. The sensitivity of CT scan to predict the necessity of operation is 100 per cent, specificity 92 per cent, accuracy 94 per cent, positive predictive value 82 per cent and negative predictive value 100 per cent. We conclude that CT scan is highly reliable in the management of blunt abdominal trauma, especially when retroperitoneal organ injuries are suspected or when there are associated major pelvic fractures. CT scan is also an invaluable tool in selected cases of non-operative management of hepatic trauma.