[Does sonographic evidence of blood in the abdomen following blunt abdominal trauma present an indication for surgery in every case?].
In a comparative study based on the diagnosis of blunt abdominal trauma, the accuracy of ultrasound (US) proved inferior, with 82-91%, to that of diagnostic peritoneal lavage, with 97-100%. The sensitivity of US, i.e. the proportion of patients with blood in the abdomen who had an abnormal test result (positive sonography) was 94%. The reasons for this may be either patient-related (severe obesity, intestinal gas superposition) or examiner-related (differing previous experience). The specificity for correct elimination of abdominal lesions was 100%. When no intra-abdominal liquid was present none appeared in the US picture; however, 3-13% of cases where intra-abdominal liquid was present this was not revealed by US. If only a small amount of intra-abdominal liquid is demonstrated after blunt trauma, the adoption of a wait-and-see attitude is justified. In intensive care conditions US can be repeated several times if necessary. In this study US showed deterioration in these circumstances in 25%, and in 21% it must be expected that an operation will be necessary.
Ruf
W
W
Abteilung für Diagnostische Radiologie, Chirurgischen Universitätsklinik Heidelberg.
Friedl
W
W
Weber
G
G
Teller
K
K
D000007:Abdominal Injuries / Q000175:diagnosis / Q000601:surgery*; D003937:Diagnosis, Differential; D006465:Hemoperitoneum / Q000601:surgery*; D006801:Humans; D010533:Peritoneal Lavage; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000601:surgery*
Stellt der sonographische Nachweis von Blut im Abdomen nach stumpfem Bauchtrauma in jedem Fall eine Operationsindikation dar?