Extravasation of intravenous computed tomography scan contrast in blunt abdominal and pelvic trauma.
BACKGROUND
Intravenous contrast extravasation (CE) on computed tomography (CT) scan in blunt abdominal trauma is generally regarded as an indication for the need for invasive intervention (either angiography or laparotomy). More recently, improvements in CT scan technology have increased the sensitivity in detecting CE, and, thus, we postulate that not all patients with this finding require intervention.


METHODS
This study is a retrospective review of all patients who underwent a CT scan for blunt abdominal trauma between January 1999 and September 2003. Patterns of injury, associated injuries, management, and outcomes were examined for patients with CE.


RESULTS
Seventy of 1,435 patients (4.8%) demonstrated CE. Mean age was 44 years and mean Injury Severity Score was 39. The location of CE was intra-abdominal in 25, pelvis/retroperitoneum in 39, and both areas in 3 patients. Six patients received supportive treatment for nonsurvivable head injury and were excluded from further analysis. Overall, 30 (47%) patients underwent immediate intervention (angiography or laparotomy) and 34 (53%) were managed nonoperatively. Of those who had initial nonoperative management, overall seven (20.5%) underwent intervention, with the remainder being managed without intervention. The success for nonoperative management was greater for those with pelvic/retroperitoneal CE (4 of 7: 57%) than for intra-abdominal extravasation (23 of 27: 85%).


CONCLUSIONS
Although evidence of CE may suggest significant vascular injury, our data suggest that not all patients require invasive intervention. Further studies are needed to better define criteria for nonoperative management in patients with CE identified on their initial CT scan.
Diamond
Ivan R
IR
Department of Surgery and the Trauma, Emergency and Critical Care Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Hamilton
Paul A
PA
Garber
Adam B
AB
Tien
Homer C
HC
Chughtai
Talat
T
Rizoli
Sandro B
SB
Tremblay
Lorraine N
LN
Brenneman
Frederick D
FD
D000328:Adult; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000601:surgery; D010384:Pelvic Bones / Q000293:injuries*; D015642:Radiology, Interventional; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000601:surgery