Computed tomographic and selective laparoscopy in the diagnosis of blunt bowel injury: A prospective study

Kitano Mitsuhide, Sasaki Junichi, Nagashima Atsushi, Doi Masakazu, Hayashi Shinobu, Egawa Tomohisa, Yoshii Hiroshi, Samir M. Fakhry, Ari Leppaniemi, Nathaniel McQuay, David H. Wisner

Research output: Contribution to journalArticlepeer-review

Abstract

Background: We prospectively evaluated whether computed tomographic (CT) scanning and selective laparoscopy (LP) for the diagnosis of blunt bowel injury (BBI) could prevent nontherapeutic laparotomy and delayed diagnosis. Methods: Between April 1994 and May 2002, hemodynamically stable patients suspected of having BBI were enrolled in this study. Patients with hemodynamic instability or solid organ injuries with hemoperitoneum were excluded. All patients underwent a physical examination and contrast CT scanning at admission and once again approximately 12 hours (range, 6-24 hours) after admission. LP was performed under general anesthesia in patients who had local peritoneal signs and indirect CT signs (bowel thickening or isolated intraperitoneal fluid) or in whom abdominal pain or tenderness increased or intraperitoneal fluid increased on the repeat CT scan. The indications for a celiotomy were diffuse peritonitis, pneumoperitoneum on the abdominal CT scan, or bowel perforation visible on LP. Results: During the study period, 399 of 1,074 patients admitted for blunt torso injuries were enrolled in this study. Eleven patients underwent emergency celiotomy and 11 underwent LP immediately after admission to the emergency department. One nontherapeutic laparotomy was performed among the patients who underwent celiotomy. The LPs revealed seven bowel perforations and one mesenteric laceration. After a repeat CT scan, three and seven of the patients underwent laparotomy and LP, respectively. Four bowel perforations were found by LP. The remaining 198 patients were treated conservatively, and no complications related to a delayed BBI diagnosis occurred. Conclusion: CT scanning and selective LP can prevent nontherapeutic laparotomy and delayed diagnosis in patients with suspected BBI.

Original languageEnglish (US)
Pages (from-to)696-703
Number of pages8
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume58
Issue number4
DOIs
StatePublished - Apr 1 2005

Keywords

  • Bowel injury
  • Computed tomographic scan
  • Laparoscopy

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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