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eISSN 2951-0805
    J Korean Soc Radiol. 2013 Jan;68(1):43-48. Korean.
    Published online Jan 29, 2013.
    https://doi.org/10.3348/jksr.2013.68.1.43
    Copyright © 2013 The Korean Society of Radiology
    Original Article

    Penetrating Stab Injuries to the Anterior Abdomen: Use of Multi-Detector Computed Tomography to Predict the Need for Laparotomy

    Dae Hong Park, MD, Seung Joon Choi, MD, Yu Mi Jeong, MD, Hyung Sik Kim, MD and Hye-Young Choi, MD
      • Department of Radiology, Gachon University, Gil Hospital, Incheon, Korea.
    • Corresponding author: Seung Joon Choi, MD. Department of Radiology, Gachon University, Gil Hospital, 1198 Guwol-dong, Namdong-gu, Incheon 405-760, Korea. Tel. 82-32-460-3060, Fax. 82-32-460-3065, Email: sjchoi@gilhospital.com
    Received August 20, 2012; Accepted November 01, 2012.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Purpose

    The aim of this study was to determine how well multi-detector computed tomography (MDCT) scans predict the need for a laparotomy in patients with anterior abdominal stab injuries.

    Materials and Methods

    Eighty patients with abdominal stab injuries who underwent MDCT scans were enrolled. MDCT was performed to identify active bleeding and injured organs and to assess the accuracy between MDCT and the laparotomy findings. MDCT was considered positive or negative with respect to the need for an exploratory laparotomy. The diagnostic performance of MDCT for identifying the need for laparotomy was estimated.

    Results

    MDCT predicted bowel and mesentery injuries in 31 of 80 patients and 28 patients were truly positive. MDCT predicted active bleeding in 23 of 80 patients and 19 patients had active bleeding. MDCT predicted the need for laparotomy in 43 of 80 patients. A laparotomy was performed in 55 of the 80 patients and 42 were therapeutic. Overall, a MDCT scan predicted the need for laparotomy with 95% sensitivity, 92% specificity, and 93% accuracy.

    Conclusion

    MDCT scans can be used to identify active bleeding and injured organs and are an effective tool for determining the need for surgical exploration.

    Keywords
    Wounds, Stab; Multi-Detector Computed Tomography; Laparotomy

    Figures

    Fig. 1
    Stab wound to anterior abdomen in a 43-year-old man.

    A. CT scan shows defect (thin arrow) in anterior abdominal wall. Hematoma in both paracolic gutter (thick arrows) with contrast material extravasation (arrowhead) in the mesentery is seen.

    B. Lower section of the CT scan of the same patient shows bowel wall thickening (black thin arrow) and free intraperitoneal air (white thin arrows). Also seen is streaking of the mesenteric fat adjacent to the thickened bowel (white arrowhead). An injury to the mesenteric vessel and ileum was confirmed surgically.

    Fig. 2
    Stab wound to anterior abdomen in a 25-year-old man. CT scan shows defect (thin arrow) in anterior abdominal wall. Free intraperitoneal fluid in mesentery and right paracolic gutter (thick arrows) with linear contrast material extravasation (arrowhead) along right side anterior abdominal wall is seen. No free intraperitoneal air is seen on CT scan. At surgery, an injury to the mesenteric vessel was seen and no bowel injury was found.

    Fig. 3
    Stab wound to anterior abdomen in a 33-year-old man. CT scan shows large mesenteric hematoma (thick arrows) including contrast material extravasation (arrowhead) adjacent inferior mesenteric artery (thin arrow). At surgery, transection of proximal inferior mesenteric artery was found.

    Tables

    Table 1
    Location of Abdominal Stab Wounds

    Table 2
    Organ Injuries in 42 Patients with Abdominal Stab Wounds

    Table 3
    Scan Findings in Patients with Perforation and Mesenteric Injuries*

    Table 4
    Diagnostic Performance of MDCT in Patients with Active Bleeding and Bowel or Mesenteric Injuries

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    MeSH Terms
    Hemorrhage
    Humans
    Laparotomy
    Mesentery
    Sensitivity and Specificity
    Wounds, Stab
    Metrics
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