The importance of empiric abdominal computed tomography after urgent laparotomy for trauma: Do they reveal unexpected injuries?

Weis, Joshua J.; Cunningham, Kelly E.; Forsythe, Raquel M.; Billiar, Timothy R.; Peitzman, Andrew B.; Sperry, Jason L.

doi:10.1016/j.surg.2014.06.044

Cited by 14 publications

(13 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results differ somewhat from those reported by Weis et al (9). However, there are major differences in study design and goals.…”

Section: Discussioncontrasting

confidence: 99%

“…Postoperative abdominopelvic CT is sometimes later performed in patients who require immediate surgery. It is our anecdotal experience that additional unsuspected injuries are commonly identified at postlaparotomy CT. To our knowledge, there has only been one study evaluating the utility of CT in this setting (9). Improved understanding of the value of postlaparotomy CT in the setting of abdominopelvic trauma may alter patient treatment, with the potential for improved patient care and outcomes.…”

Section: Study Populationmentioning

confidence: 99%

See 1 more Smart Citation

Diagnostic Yield and Clinical Utility of Abdominopelvic CT Following Emergent Laparotomy for Trauma

Haste¹,

Brewer²,

Steenburg³

2016

Radiology

View full text Add to dashboard Cite

Purpose To determine the incidence of unexpected injuries that are diagnosed with computed tomography (CT) after emergent exploratory laparotomy for trauma and whether identification of such injuries results in additional surgery or angiography. Materials and Methods This HIPAA-compliant retrospective study was approved by the institutional review board, and the requirement for informed consent was waived. The trauma databases of two urban level 1 trauma centers were queried over a period of more than 5 years for patients who underwent abdominopelvic CT within 48 hours of emergent exploratory laparotomy for trauma. Comparisons were made between CT findings and those described in the surgical notes. Descriptive statistics were generated, and 95% confidence intervals (CIs) were determined by using an exact method based on a binomial distribution. Results The study cohort consisted of 90 patients, including both blunt and penetrating trauma victims with a median injury severity score of 17.5 (interquartile range, 9.25-34). Seventy-three percent (66 of 90) of patients sustained penetrating trauma, 82% (74 of 90) of whom were male. A total of 19 patients (21.1%; 95% CI: 13.2, 31.0) had additional injuries within the surgical field that were not identified during laparotomy. There were 17 unidentified solid organ injuries, and eight patients had active bleeding within the surgical field. Eight patients (8.9%; 95% CI: 3.9, 16.8) had unexpected injuries at CT that were substantial enough to warrant additional surgery or angiography. In addition, previously undiagnosed fractures were found in 45 patients (50%; 95% CI: 39.3, 60.7). Conclusion Performing CT after emergent exploratory laparotomy for trauma is useful in identifying unexpected injuries and confirming suspected injuries that were not fully explored at initial surgery. (©) RSNA, 2016.

show abstract

“…Our results differ somewhat from those reported by Weis et al (9). However, there are major differences in study design and goals.…”

Section: Discussioncontrasting

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

Diagnostic Yield and Clinical Utility of Abdominopelvic CT Following Emergent Laparotomy for Trauma

Haste¹,

Brewer²,

Steenburg³

2016

Radiology

View full text Add to dashboard Cite

show abstract

“…The vast majority of injuries included orthopedic injuries (20) and genitourinary injuries. 9 There were some new solid organ injuries 7 and vascular injuries 7 identified as well. Ten patients (26.3%) had injuries that required intervention.…”

Section: Resultsmentioning

confidence: 99%

“…[4][5][6] Recently, CT imaging has increased in the early postoperative period in patients with penetrating thoracoabdominal trauma. 7,8 In general, we believe there are four main indications for using CT imaging in this setting:…”

mentioning

confidence: 99%

Routine computed tomography after recent operative exploration for penetrating trauma

Mendoza

Wybourn

Charles³

et al. 2017

Journal of Trauma and Acute Care Surgery

View full text Add to dashboard Cite

show abstract

“…In patients with abdominal trauma who are hemodynamically stable, CT with intravenous contrast material is the imaging modality of choice (17), but the optimal use of imaging in patients undergoing DCS without preoperative imaging is an area of continued study (18)(19)(20)(21)(22)(23). A CT examination performed in the early perioperative period may allow identification of injuries that require additional intervention or occult injuries in or beyond the surgical field and may provide the potential to change the patient treatment plan.…”

Section: Imaging After Dcsmentioning

confidence: 99%

Multidetector CT Findings in the Abdomen and Pelvis after Damage Control Surgery for Acute Traumatic Injuries

et al. 2019

View full text Add to dashboard Cite

After experiencing blunt or penetrating trauma, patients in unstable condition who are more likely to die of uncorrected shock than of incomplete injury repairs undergo emergency limited exploratory laparotomy, which is also known as damage control surgery (DCS). This surgery is part of a series of resuscitation steps, with the goal of stabilizing the patient's condition, with rapid surgical control of hemorrhage followed by supportive measures in the intensive care unit before definitive repair of injuries. These patients often are imaged with multidetector CT within 24-48 hours of the initial surgery. Knowledge of this treatment plan is critical to CT interpretation, because there are anatomic derangements and foreign bodies that would not be present in patients undergoing surgery for other reasons. Patients may have injuries beyond the surgical field that are only identified at imaging, which can alter the care plan. Abnormalities related to the resuscitation period such as the CT hypoperfusion complex and ongoing hemorrhage can be recognized at CT. Familiarity with these imaging and clinical findings is important, because they can be seen not only in trauma patients after DCS but also in other patients in the critical care setting. The interpretation of imaging studies can be helped by an understanding of the diagnostic challenges of grading organ injuries with surgical materials in place and the awareness of potential artifacts on images in these patients.

show abstract

The importance of empiric abdominal computed tomography after urgent laparotomy for trauma: Do they reveal unexpected injuries?

Cited by 14 publications

References 11 publications

Diagnostic Yield and Clinical Utility of Abdominopelvic CT Following Emergent Laparotomy for Trauma

Diagnostic Yield and Clinical Utility of Abdominopelvic CT Following Emergent Laparotomy for Trauma

Routine computed tomography after recent operative exploration for penetrating trauma

Multidetector CT Findings in the Abdomen and Pelvis after Damage Control Surgery for Acute Traumatic Injuries

Contact Info

Product

Resources

About