The role of computerized tomography in penetrating abdominal trauma

ABSTRACT Objective: to evaluate the role of abdominal computed tomography in the management of penetrating abdominal trauma. Methods: we conducted a historical cohort study of patients treated for penetrating trauma in the anterior abdomen, dorsum or thoracoabdominal transition, that were submitted to a computed tomography carried out on admission. We evaluated the location of the wound and the presence of tomographic findings, and the management of these patients as for nonoperative treatment or laparotomy. We calculated the sensitivity and specificity of computed tomography according to the evolution of the nonoperative treatment or the surgical findings. Results: we selected 61 patients, 31 with trauma to the anterior abdomen and 30 to the dorsum or thoracoabdominal transition. The mortality rate was 6.5% (n=4), all in the late postoperative period. Eleven patients with trauma to the anterior abdomen were submitted to nonoperative treatment, and 20, to laparotomy. Of the 30 patients with trauma to the dorsum or thoracoabdominal transition, 23 underwent nonoperative treatment and seven, laparotomy. There were three nonoperative treatment failures. In penetrating trauma of the anterior abdomen, the sensitivity of computed tomography was 94.1% and the negative predictive value was 93.3%. In dorsal or thoracoabdominal transition lesions, the sensitivity was 90% and the negative predictive value was 95.5%. In both groups, the specificity and the positive predictive value were 100%. Conclusion: the accuracy of computed tomography was adequate to guide the management of stable patients who could be treated conservatively, avoiding mandatory surgery in 34 patients and reducing the morbidity and mortality of non-therapeutic laparotomies.

摘要
目的：评估腹部计算机断层扫描（computed tomography）在腹部穿透性创伤诊疗中的应用价值。
方法：针对因前腹部、背部或胸腹移行区穿透性创伤接受治疗，且于入院时接受计算机断层扫描的患者，开展一项回顾性队列研究。本研究评估了创伤部位、影像学表现情况，并依据非手术治疗或剖腹手术的诊疗方案对患者进行管理；同时根据非手术治疗转归或手术探查结果，计算了计算机断层扫描的灵敏度与特异度。
结果：本研究共纳入61例患者，其中31例为前腹部创伤，30例为背部或胸腹移行区创伤。总死亡率为6.5%（n=4），所有死亡病例均发生于术后晚期。11例前腹部创伤患者接受非手术治疗，20例接受剖腹手术；在30例背部或胸腹移行区创伤患者中，23例接受非手术治疗，7例接受剖腹手术。共出现3例非手术治疗失败病例。在前腹部穿透性创伤中，计算机断层扫描的灵敏度为94.1%，阴性预测值为93.3%；在背部或胸腹移行区创伤中，其灵敏度为90%，阴性预测值为95.5%。两组的特异度与阳性预测值均为100%。
结论：计算机断层扫描的准确度足以指导稳定型患者的保守治疗决策，可使34例患者避免了本需实施的手术，同时降低非治疗性剖腹手术的并发症发生率与死亡率。