Gunshot Wounds of Abdomen

Evaluation of Stable Patients with Triple-Contrast Helical CT

Felipe Munera, Carlos Morales, Jorge A. Soto, Hector I. Garcia, Tatiana Suarez, Vanessa Garcia, Mauricio Corrales, Guillermo Velez

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

PURPOSE: To assess helical computed tomography (CT) with contrast material administered intravenously, orally, and rectally (triple contrast helical CT)) in the prospective evaluation of stable patients with abdominal gunshot wounds in whom there is no clinical indication for immediate exploratory laparotomy. MATERIALS AND METHODS: The study was conducted for 19 months. All patients met the following inclusion criteria: age of 16 years or older, hemodynamic stability, no clinical signs of peritoneal irritation, and signed consent to participate. Patients with obvious indications for laparotomy, such as gastrointestinal bleeding or evisceration, were excluded from the study. Forty-seven patients fulfilled the criteria and underwent abdominal triple-contrast helical CT. CT findings were evaluated by one of four radiologists for evidence of peritoneal penetration and injury to solid organs or hollow viscera. Patients were followed up clinically for 13 weeks. CT findings were compared with those at surgery and/or clinical follow-up. RESULTS: CT demonstrated abnormalities in 27 (57%) patients. Laparotomy was performed in 11 (23%) patients; 10 procedures were therapeutic and one was nontherapeutic. The remaining 20 patients had a negative CT scan. These patients were treated conservatively. One injury was missed at CT. For prediction of the need for laparotomy, sensitivity of CT was 96%; specificity, 95%; positive predictive value, 96%; negative predictive value, 95%; and accuracy, 96%. CONCLUSION: In stable patients with gunshot wounds to the abdomen in whom there is no indication for immediate surgery, triple-contrast helical CT can help reduce the number of cases of unnecessary or nontherapeutic laparotomy (negative laparotomy) and can help identify patients with injuries that may be safely treated without surgery.

Original languageEnglish
Pages (from-to)399-405
Number of pages7
JournalRadiology
Volume231
Issue number2
DOIs
StatePublished - May 1 2004

Fingerprint

Gunshot Wounds
Spiral Computed Tomography
Abdomen
Laparotomy
Tomography
Wounds and Injuries
Viscera
Contrast Media
Hemodynamics
Hemorrhage

Keywords

  • Abdomen, CT
  • Abdomen, injuries
  • Computed tomography (CT), clinical effectiveness
  • Gunshot injuries
  • Trauma

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology

Cite this

Munera, F., Morales, C., Soto, J. A., Garcia, H. I., Suarez, T., Garcia, V., ... Velez, G. (2004). Gunshot Wounds of Abdomen: Evaluation of Stable Patients with Triple-Contrast Helical CT. Radiology, 231(2), 399-405. https://doi.org/10.1148/radiol.2312030027

Gunshot Wounds of Abdomen : Evaluation of Stable Patients with Triple-Contrast Helical CT. / Munera, Felipe; Morales, Carlos; Soto, Jorge A.; Garcia, Hector I.; Suarez, Tatiana; Garcia, Vanessa; Corrales, Mauricio; Velez, Guillermo.

In: Radiology, Vol. 231, No. 2, 01.05.2004, p. 399-405.

Research output: Contribution to journalArticle

Munera, F, Morales, C, Soto, JA, Garcia, HI, Suarez, T, Garcia, V, Corrales, M & Velez, G 2004, 'Gunshot Wounds of Abdomen: Evaluation of Stable Patients with Triple-Contrast Helical CT', Radiology, vol. 231, no. 2, pp. 399-405. https://doi.org/10.1148/radiol.2312030027
Munera, Felipe ; Morales, Carlos ; Soto, Jorge A. ; Garcia, Hector I. ; Suarez, Tatiana ; Garcia, Vanessa ; Corrales, Mauricio ; Velez, Guillermo. / Gunshot Wounds of Abdomen : Evaluation of Stable Patients with Triple-Contrast Helical CT. In: Radiology. 2004 ; Vol. 231, No. 2. pp. 399-405.
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N2 - PURPOSE: To assess helical computed tomography (CT) with contrast material administered intravenously, orally, and rectally (triple contrast helical CT)) in the prospective evaluation of stable patients with abdominal gunshot wounds in whom there is no clinical indication for immediate exploratory laparotomy. MATERIALS AND METHODS: The study was conducted for 19 months. All patients met the following inclusion criteria: age of 16 years or older, hemodynamic stability, no clinical signs of peritoneal irritation, and signed consent to participate. Patients with obvious indications for laparotomy, such as gastrointestinal bleeding or evisceration, were excluded from the study. Forty-seven patients fulfilled the criteria and underwent abdominal triple-contrast helical CT. CT findings were evaluated by one of four radiologists for evidence of peritoneal penetration and injury to solid organs or hollow viscera. Patients were followed up clinically for 13 weeks. CT findings were compared with those at surgery and/or clinical follow-up. RESULTS: CT demonstrated abnormalities in 27 (57%) patients. Laparotomy was performed in 11 (23%) patients; 10 procedures were therapeutic and one was nontherapeutic. The remaining 20 patients had a negative CT scan. These patients were treated conservatively. One injury was missed at CT. For prediction of the need for laparotomy, sensitivity of CT was 96%; specificity, 95%; positive predictive value, 96%; negative predictive value, 95%; and accuracy, 96%. CONCLUSION: In stable patients with gunshot wounds to the abdomen in whom there is no indication for immediate surgery, triple-contrast helical CT can help reduce the number of cases of unnecessary or nontherapeutic laparotomy (negative laparotomy) and can help identify patients with injuries that may be safely treated without surgery.

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