The management of blunt abdominal trauma patients with computed tomography scan findings of free peritoneal fluid and no evidence of solid organ injury

Modalities available for the diagnosis of blunt abdominal traumatic (BAT) injuries include focused abdominal sonography for trauma, diagnostic peritoneal lavage, and computed tomography (CT) of the abdomen/pelvis. Hollow viscous and/or mesenteric injury (HVI/MI) can still be challenging to diagnose. Specifically, there is debate as to the proper management of BAT when CT findings include free peritoneal fluid but no evidence of solid organ injury (SOI). Our objective was to determine the incidence of HVI/MI and to evaluate the management of BAT patients with CT findings of peritoneal fluid without evidence of SOI. An Institutional Review Board-approved retrospective chart review was conducted of all BAT patients with peritoneal fluid on CT admitted to Kern Medical Center from January 1, 2003 to July 31, 2004. A total of 2651 trauma admissions yielded 79 patients. Fourteen of these had no evidence of SOI. Nonoperative management was successful in only 2 of these 14, whereas 12 required an operation, with 11 being therapeutic. Trigger to operate and time from presentation to laparotomy was hypotension in three patients (164 minutes), signs of HVI/MI on CT in two patients (235 minutes), diaphragm injury on CT in one patient (95 minutes), and for peritoneal signs in six patients (508 minutes). In BAT patients with peritoneal fluid on CT without evidence of SOI, there should be a high suspicion of HVI/MI. Relying on increasing abdominal tenderness to trigger laparotomy can result in delayed treatment.