Incidence of unexplained intra-abdominal free fluid in patients with blunt abdominal trauma.
BACKGROUND
Intra-abdominal free fluid is commonly caused by injuries of solid or hollow organs in patients suffering from blunt abdominal trauma (BAT). However, it presents a diagnostic dilemma for surgeons when free fluid is unexplained, especially in stable BAT patients. This study was to analyze the incidence of such unexplained free fluid in BAT patients and its diagnostic value in abdominal organ injury.


METHODS
Altogether 597 patients with BAT who had been treated at our trauma center over a 10-year period were reviewed. Stable patients with free fluid but without free air or definite organ injury on abdominal computed tomography were studied. Clinical management and operative findings were analyzed.


RESULTS
Thirty-four (5.70%) of the 597 patients met the inclusion criteria: 24 (4.02%) underwent therapeutic exploratory laparotomy: bowel injuries were found in 13, hepatic rupture in 3, colon rupture in 3, duodenal rupture in 2, spleen rupture in 1, pancreas rupture in 1, and gallbladder perforation in 1. In 2 patients, laparotomy was nontherapeutic. Those with moderate or large amounts of free fluid were more likely to suffer from a hollow viscus injury and have a therapeutic procedure. The mean time of hospital stay for the delayed laparotomy group was longer than that for the emergency group (19+/-5.12 vs. 12+/-2.24 days; t=2.73, P<0.01).


CONCLUSIONS
There was a positive correlation between the amount of unexplained free fluid and the determination of intra-abdominal organ injury. The proportion of BAT patients who required surgical intervention was high, particularly those with a moderate or large amount of free fluid, and most of them suffered from a hollow organ injury. Emergency laparotomy is recommended for these patients.
Chen
Zuo-Bing
ZB
Department of General Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China. chenzuobing@hotmail.com
Zhang
Yun
Y
Liang
Zhong-Yan
ZY
Zhang
Shao-Yang
SY
Yu
Wen-Qiao
WQ
Gao
Yuan
Y
Zheng
Shu-Sen
SS
D000007:Abdominal Injuries / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery; D001826:Body Fluids / Q000000981:diagnostic imaging; D006801:Humans; D015994:Incidence; D007813:Laparotomy; D007902:Length of Stay; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D036542:Tomography, Spiral Computed; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery