[Diagnostic strategy of abdominal contusions in adults]

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