Society of Black Academic Surgeons
Diagnosing blunt hollow viscus injury: is computed tomography the answer?

https://doi.org/10.1016/j.amjsurg.2012.12.003Get rights and content

Abstract

Background

Blunt hollow viscus injury (BHVI) is challenging to diagnose. The purpose of this study was to determine the reliability of physical exam and the role of computed tomography (CT) in the diagnosis of BHVI.

Methods

All blunt abdominal trauma (BAT) admissions to a level 1 trauma center from January 2009 through December 2011 were identified through the trauma registry. Data collected included demographics and findings on CT and physical exam.

Results

Of 2,912 patients with blunt trauma, 340 had BAT, and 30 (9%) had BHVIs. The sensitivity and specificity of CT were 86% and 88%, respectively, whereas the sensitivity and specificity of clinical exam were 53% and 69%. Twenty-seven percent of patients with BAT and bladder injuries had concomitant BHVIs.

Conclusions

This is the largest single series of BHVI after BAT. CT is superior to clinical exam in establishing the diagnosis of BHVI. Although associated injuries are common, bladder injury may be an important marker for BHVI.

Section snippets

Methods

Hartford Hospital is an 800-bed, level 1 tertiary care center in central Connecticut serving a catchment area that includes northern and central Connecticut as well as eastern New York, parts of southern Massachusetts, and southwestern Rhode Island. After obtaining institutional review board approval, we retrospectively reviewed the medical records of patients identified from the trauma registry aged ≥18 years admitted for blunt trauma from January 2009 through December 2011. We then extracted

Results

During the study period, 2,912 patients were admitted after sustaining blunt trauma. Of these, 340 (12%) sustained BAT, and 30 (9%) patients from that group had BHVIs. Of the 340 patients reviewed, 1 died, and all but 2 patients with BHVIs were evaluated using CT, providing 337 evaluable computed tomographic reports. One of the 2 patients presented with hypotension, had positive results on focused abdominal sonography for trauma, and was taken directly to the operating room, where injury to the

Comments

Our retrospective review revealed a 9.0% incidence of BHVI in patients admitted with BAT. This series is, to our knowledge, the largest single-center series of BHVI reported. It is important to differentiate the incidence of BHVI in all blunt trauma admissions (1.0%) from those with BAT. The group of patients admitted after blunt trauma is extremely heterogeneous and includes patients with nonabdominal trauma who are not at risk for BHVI. Moreover, we found that not surprisingly, CT had higher

Conclusions

The results of this study identify unexpected findings: patients in whom BHVIs were missed on CT all had evidence of bladder injuries. Although the finding of bladder injury was not a significant predictor of risk for BHVI, the overall sample size was small given the low frequency with which BHVI is identified. The present study cannot confirm or refute the presence of bladder injury as a marker for BHVI, but it is interesting that 27% of patients with BAT and bladder injuries had concomitant

References (18)

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The authors declare no conflicts of interest.

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