title: Computed tomographic scanning and selective laparoscopy in the diagnosis of blunt bowel injury: a prospective study.
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.
  
  
  CONCLUSIONS
  CT scanning and selective LP can prevent nontherapeutic laparotomy and delayed diagnosis in patients with suspected BBI.
authors.affiliation: Department of Surgery, Saiseikai-Kanagawaken Hospital, Yokohama, Japan. mitsu-kitano@mtd.biglobe.ne.jp
authors.forename: Kitano
authors.initials: K
authors.lastname: Mitsuhide
authors.forename: Sasaki
authors.initials: S
authors.lastname: Junichi
authors.forename: Nagashima
authors.initials: N
authors.lastname: Atsushi
authors.forename: Doi
authors.initials: D
authors.lastname: Masakazu
authors.forename: Hayashi
authors.initials: H
authors.lastname: Shinobu
authors.forename: Egawa
authors.initials: E
authors.lastname: Tomohisa
authors.forename: Yoshii
authors.initials: Y
authors.lastname: Hiroshi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D007421:Intestine, Small / Q000293:injuries*; D010535:Laparoscopy; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000209:etiology; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery