The role of computed tomography in selective management of gunshot wounds to the abdomen and flank.
OBJECTIVE
To determine whether computed tomography (CT) is an accurate diagnostic modality for the triage of hemodynamically stable patients with gunshot wounds of the abdomen and flank.


METHODS
A chart review of 83 trauma patients for whom abdominal CT was used as initial screening.


RESULTS
In 53 patients, CT revealed no evidence of peritoneal penetration, and in 15 patients, there was evidence of either peritoneal penetration or liver injury. There were no false results in these patients. Among 15 patients with questionable peritoneal penetration, cavitary endoscopy was performed in 11 and exploratory laparotomy was performed in 3, and 1 patient was initially observed and subsequently underwent exploratory surgery for a missed colonic injury.


CONCLUSIONS
In selected centers and in hemodynamically stable patients with abdominal and flank gunshot wounds, abdominal CT can be an effective and safe initial screening modality to document the presence or absence of peritoneal penetration and to manage nonoperatively stable patients with liver injuries. If there is any question of peritoneal penetration, cavitary endoscopy should be part of the protocol of nonoperative management.
Ginzburg
E
E
Department of Surgery, Division of Trauma Services, University of Miami School of Medicine, and the Ryder Trauma Center, Florida, USA.
Carrillo
E H
EH
Kopelman
T
T
McKenney
M G
MG
Kirton
O C
OC
Shatz
D V
DV
Sleeman
D
D
Martin
L C
LC
D000007:Abdominal Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000465:Algorithms; D003663:Decision Trees; D005260:Female; D006801:Humans; D007813:Laparotomy; D008297:Male; D008499:Medical Records; D010537:Peritoneum / Q000000981:diagnostic imaging / Q000293:injuries*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014948:Wounds, Gunshot / Q000000981:diagnostic imaging* / Q000601:surgery