Abdominal Trauma - Diagnosis

Diagnosis

One study found that ten percent of polytrauma patients who had no clinical signs of abdominal injury did have evidence of the such injuries using radiological imaging. Diagnostic techniques used include CT scanning, ultrasound, and X-ray. X-ray can help determine the path of a penetrating object and locate any foreign matter left in the wound, but may not be helpful in blunt trauma. Diagnostic peritoneal lavage is a controversial technique but can be used to detect injury to abdominal organs: a catheter is placed in the peritoneal cavity, and if fluid is present, it is aspirated and examined for blood or evidence of organ rupture. If this does not reveal evidence of injury, sterile saline is infused into the cavity and evacuated and examined for blood or other material. While peritoneal lavage is an accurate way to test for bleeding, it carries a risk of injuring the abdominal organs, may be difficult to perform, and may lead to unnecessary surgery; thus it has largely been replaced by ultrasound in Europe and North America. Ultrasound can detect fluid such as blood or gastrointestinal contents in the abdominal cavity, and it is a noninvasive procedure and relatively safe for the patient. CT scanning is the preferred technique for people who are not at immediate risk of shock, but since ultrasound can be performed right in an emergency room, the latter is recommended for people who are not stable enough to move to CT scanning. However, people with abdominal trauma frequently need CT scans for other trauma (for example, head or chest CT); in these cases abdominal CT can be performed at the same time without wasting time in patient care. Diagnostic laparoscopy or exploratory laparotomy may also be performed if other diagnostic methods do not yield conclusive results.