The Impact of Free Intra-Peritoneal Fluid on Computed Tomography Following Blunt Trauma
William Tobler, MD, Peter Burke, MD, FACS, Suresh Agarwal, MD, FACS
Boston Medical Center, Boston, MA
PURPOSE OF STUDY
To evaluate the significance of free intra-peritoneal fluid on CT following blunt abdominal trauma in male patients without solid organ injury. This study examines the effectiveness of CT scan in determining operative vs. non-operative management.
A retrospective study was performed on 745 blunt abdominal traumas in male patients at a single-center university setting level 1 trauma center from 11/2001 to 10/2008. Data was accessed from a trauma database and a chart review was performed. Inclusion criteria were free intra-peritoneal fluid on CT in male patients following blunt abdominal trauma. Patients with solid organ injury on CT, females, and penetrating injuries were excluded.
SUMMARY OF RESULTS
745 CT scans were evaluated and 63 patients met the criteria. The locations of free fluid were divided into seven sections: perisplenic, perihepatic, Morriison’s pouch, mesentery/small bowel, right paracolic gutter, left paracolic gutter, and pelvis. 100% of patients with fluid in three or more locations (n=14) were taken to the OR, and 92.8% (n=15) underwent therapeutic procedures. 77.7% of patient had free fluid in two or less locations (n=49). 32.6% (n=16) of these patients were taken to the OR and 93.8% (n=15) had therapeutic procedures performed. Of the remaining patients 30 were treated non-operatively for their abdominal abnormalities on CT, 2 died secondary to PE after prolonged hospital course, and 1 was treated with angiography.
CT scan alone cannot effectively determine the necessity for operative care in patients with free fluid in the abdomen following blunt abdominal trauma. The distribution of free fluid in the abdomen, however, is a helpful adjunct in making clinical decisions. Patients with fluid located in less than 2 intra-peritoneal locations and stable clinical presentation can be treated conservatively. When CT demonstrates free fluid in three or more locations the necessity for operative intervention increases. Finally, CT scans failed to diagnose multiple hollow viscus and solid organ injuries that were later revealed in the operating room. Therefore, the presence of free fluid should always raise clinical suspicion for injury requiring intervention.