title: Significance of computed tomography finding of intra-abdominal free fluid without solid organ injury after blunt abdominal trauma: time for laparotomy on demand.
abstract: BACKGROUND
  Optimal management of patients with intra-abdominal free fluid found on computed tomography (CT) scan without solid organ injury remains controversial.
  
  
  OBJECTIVE
  The purpose of this study was to determine the significance of CT scan findings of free fluid in the management of blunt abdominal trauma patients who otherwise have no indications for laparotomy.
  
  
  METHODS
  During the 3-year study period, all patients presenting with blunt abdominal trauma who underwent abdominal CT examination were retrospectively reviewed. All hemodynamically stable patients who presented with abdominal free fluid without solid organ injury on CT scan were analyzed for radiological interpretation, clinical management, operative findings, and outcome.
  
  
  RESULTS
  A total of 122 patients were included in the study, 91 % of whom were males. The mean age of the patients was 33 ± 12 years. A total of 34 patients underwent exploratory laparotomy, 31 of whom had therapeutic interventions. Small bowel injuries were found in 12 patients, large bowel injuries in ten, and mesenteric injuries in seven patients. One patient had combined small and large bowel injury, and one had traumatic gangrenous appendix. In the remaining three patients, laparotomy was non-therapeutic. A total of 36 patients had associated pelvic fractures and 33 had multiple lumbar transverse process fractures.
  
  
  CONCLUSIONS
  Detection of intra-peritoneal fluid by CT scan is inaccurate for prediction of bowel injury or need for surgery. However, the correlation between CT scan findings and clinical course is important for optimal diagnosis of bowel and mesenteric injuries.
authors.affiliation: Trauma Intensive Care Unit, Section of Trauma, Department of Trauma, Surgery, Hamad Medical Corporation, PO Box 3050, Doha, Qatar, traumaresearch@hmc.org.qa.
authors.forename: Ismail
authors.initials: I
authors.lastname: Mahmood
authors.forename: Zainab
authors.initials: Z
authors.lastname: Tawfek
authors.forename: Yassir
authors.initials: Y
authors.lastname: Abdelrahman
authors.forename: Tariq
authors.initials: T
authors.lastname: Siddiuqqi
authors.forename: Husham
authors.initials: H
authors.lastname: Abdelrahman
authors.forename: Ayman
authors.initials: A
authors.lastname: El-Menyar
authors.forename: Ammar
authors.initials: A
authors.lastname: Al-Hassani
authors.forename: Mazin
authors.initials: M
authors.lastname: Tuma
authors.forename: Ruben
authors.initials: R
authors.lastname: Peralta
authors.forename: Ahmad
authors.initials: A
authors.lastname: Zarour
authors.forename: Sawsan
authors.initials: S
authors.lastname: Yakhlef
authors.forename: Hazim
authors.initials: H
authors.lastname: Hamzawi
authors.forename: Hassan
authors.initials: H
authors.lastname: Al-Thani
authors.forename: Rifat
authors.initials: R
authors.lastname: Latifi
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D000328:Adult; D001202:Ascitic Fluid / Q000000981:diagnostic imaging*; D015331:Cohort Studies; D003906:Developing Countries; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007422:Intestines / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D007813:Laparotomy / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011780:Qatar; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000601:surgery; D055815:Young Adult