Gunshot Wounds of Abdomen: Evaluation of Stable Patients with Triple-Contrast Helical CT

Múnera, Felipe; Morales, Carlos; Soto, Jorge A.; García, Héctor Iván; Suárez, Tatiana; García, Vanessa; Corrales, Mauricio; Velez, Guillermo

doi:10.1148/radiol.2312030027

Cited by 95 publications

(55 citation statements)

References 44 publications

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“…[7][8][9][10][11][12] It has also been used with excellent results to evaluate the retroperitoneum in patients with flank and back stab wounds. 4,5 The experience with AASWs is much more limited.…”

Section: Commentmentioning

confidence: 99%

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Use of Computed Tomography in Anterior Abdominal Stab Wounds

Salim¹

2006

Arch Surg

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Setting: Academic level I trauma center.Patients and Methods: All of the patients sustaining AASWs, excluding those with hemodynamic instability, peritonitis, or omental evisceration, were admitted for serial abdominal examinations with or without CT depending on attending preference. Patients with associated left thoracoabdominal stab wounds underwent diagnostic laparoscopy.Main Outcome Measures: Change in patient management as a direct result of the CT scan findings, as well as sensitivity, specificity, positive predictive value, and negative predictive value of CT scanning calculated against clinical outcome (the need for laparotomy, uneventful discharge without laparotomy, or return to the hospital for adverse events).Results: One hundred fifty-six consecutive patients with AASWs were included over 24 months. Computed tomography was performed for 67 patients (CT group) whereas 89 patients were admitted for serial examination only (no-CT group). Nineteen of the 67 patients in the CT group had positive CT results, leading to laparotomy in 10 patients. Of the 48 patients with negative CT results, 3 underwent diagnostic laparoscopy for an associated thoracoabdominal stab wound and 2 eventually underwent laparotomy for clinical deterioration with negative results. Excluding patients with associated thoracoabdominal stab wounds, the negative predictive value of CT was 100%. Conclusions:In patients with AASWs, CT can be used to identify visceral injuries. It is a promising tool that may identify patients who can be discharged after a shorter period of observation. Further evaluation of its use in patients with AASWs is warranted.

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Section: Commentmentioning

confidence: 99%

“…[4][5][6] Computed tomography has also been used to determine bullet trajectory after abdominal gunshot wounds with encouraging results. [7][8][9][10] The role of CT in evaluating patients with AASWs remains unknown.…”

mentioning

confidence: 99%

Use of Computed Tomography in Anterior Abdominal Stab Wounds

Salim¹

2006

Arch Surg

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“…Computed tomography of the abdomen, besides being one of the protocol items, has a number of advantages and is essential for this kind of approach, there being evidence level II recommendations 16 . With the advancement of technology, multidetector CT has a sensitivity of 91% to 97%, a specificity of 96% to 98% and an accuracy of 96% to 98% in detecting intra-abdominal injuries in patients with GSW abdominal injuries [17][18][19] . Among the benefits of NOM are the decreasing frequencies of unnecessary laparotomies and their complications, length of hospital stays and overall treatment costs.…”

Section: Results Results Results Resultsmentioning

confidence: 99%

Isolated liver gunshot injuries: nonoperative management is feasible?

Starling

Azevedo

Santana

et al. 2015

Rev. Col. Bras. Cir.

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Objective:to evaluate the safety and effectiveness of non-operative management (NOM) of liver injury, being the only abdominal injury, from gunshot wounds to the abdomen.Methods:patients who had liver damage diagnosed as single abdominal injury caused by PAF in the right thoracoabdominal region, hemodynamically stable were studied. All underwent examination with computed tomography. Were analyzed: age, gender, levels of trauma, hemodynamic condition and the abdominal examination on admission, the results of the CT scan, the extra-abdominal lesions found, the serum levels of hemoglobin, clinical course, complications, length of hospital stay, outpatient treatment and death.Results:during the study period 169 patients, treated non-operatively, presented liver gunshot wounds. Of these, only 28 patients (16.6%) had liver injury as the only abdominal injury and consequently met the inclusion criteria for this study. The average age was 27.7 years and 25 patients (89.2%) were male. The overall average of verified trauma scores were: RTS 7.45, ISS 10.9, and TRISS 98.7%. The most frequent injuries were grade II and grade III (85.7%). Complications occurred in only one patient who presented a progressive decline in hemoglobin. He underwent a CT scan which showed blush in the liver parenchyma. An arteriography was performed, which showed a successfully embolized arteriovenous fistula. There were no deaths in the patient sample. The average hospital stay was 5.3 days.Conclusion:isolated hepatic injury in gunshot abdominal trauma is uncommon. However, the NOM protocol for this type of injury is safe and has low morbidity. This approach should only be followed in institutions with adequate infrastructure, where an experienced and cohesive team is able to follow a specific protocol, with rigorous periodic evaluation of its results.

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“…A delayed or recurrent accumulation of simple density pleural fluid may also suggest thoracic duct injury, which is associated with chylous thoracostomy tube drainage [59]. VATS may be performed for evacuation of retained hemothorax that fails multiple attempts at thoracostomy drainage, for empyema with tenacious adhesions, or for late-phase fibrothorax [2,57].…”

Section: Chest Complicationsmentioning

confidence: 99%

“…The majority of torso gunshot wound and some stab wound victims are hemodynamically unstable or have overt peritoneal signs and undergo exploration without pre-operative CT [1][2][3][4]. Multiple injuries are seen in most torso gunshot wounds, and patients in shock will often require initial damage control surgery, during which hematomas are explored, bleeding vessels are ligated, and splenectomies and single nephrectomies are performed in unsalvageable cases.…”

Section: Introductionmentioning

confidence: 99%

MDCT of complications and common postoperative findings following penetrating torso trauma

2015

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Victims of penetrating torso trauma often present with findings that necessitate emergent exploratory laparotomy, precluding scanning with multidetector computed tomography (MDCT) until the postoperative period. This article reviews the wide range of complications as well as expected findings that may be encountered at MDCT performed postoperatively. Little has been written to guide the radiologist in interpreting these often complex and potentially confusing studies.

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Gunshot Wounds of Abdomen: Evaluation of Stable Patients with Triple-Contrast Helical CT

Cited by 95 publications

References 44 publications

Use of Computed Tomography in Anterior Abdominal Stab Wounds

Use of Computed Tomography in Anterior Abdominal Stab Wounds

Isolated liver gunshot injuries: nonoperative management is feasible?

MDCT of complications and common postoperative findings following penetrating torso trauma

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