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| Victor Y. Kong,Damon Jeetoo,Leah C. Naidoo,George V. Oosthuizen,Damian L. Clarke.[J].Chin J Traumatol,2015,18(6):357-359. [doi] |
| Isolated free intra-abdominal fluid on CT in blunt trauma: The continued diagnostic dilemma |
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| DOI： |
| KeyWord: Blunt Trauma
Computed Tomography
Non Operative Management
Abdominal Injury |
| FundProject: |
| Author Name | Affiliation | | Victor Y. Kong | Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, Nelson R Mandela School of Medicine, University of KwaZulu Natal | | Damon Jeetoo | Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, Nelson R Mandela School of Medicine, University of KwaZulu Natal | | Leah C. Naidoo | Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, Nelson R Mandela School of Medicine, University of KwaZulu Natal | | George V. Oosthuizen | Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, Nelson R Mandela School of Medicine, University of KwaZulu Natal | | Damian L. Clarke | Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, Nelson R Mandela School of Medicine, University of KwaZulu Natal |
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| Abstract: |
| Purpose: The clinical significance of isolated free fluid (FF) without solid organ injury on computed tomography (CT) continues to pose significant dilemma in the management of patients with blunt
abdominal trauma (BAT).
Methods: We reviewed the incidence of FF and the clinical outcome amongst patients with blunt
abdominal trauma in a metropolitan trauma service in South Africa. We performed a retrospective study
of 121 consecutive CT scans over a period of 12 months to determine the incidence of isolated FF and the clinical outcome of patients managed in a large metropolitan trauma service.
Results: Of the 121 CTs, FF was identified in 36 patients (30%). Seven patients (6%) had isolated FF. Of the 29 patients who had free fluid and associated organ injuries, 33 organ injuries were identified. 86% (25/29) of all 29 patients had a single organ injury and 14% had multiple organ injuries. There were 26 solid organ injuries and 7 hollow organ injuries. The 33 organs injured were: spleen, 12; liver, 8; kidney, 5;pancreas, 2; small bowel, 4; duodenum, 1. Six (21%) patients required operative management for small bowel perforations in 4 cases and pancreatic tail injury in 2 cases. All 7 patients with isolated FF were initially observed, and 3 (43%) were eventually subjected to operative intervention. They were found to have an intra-peritoneal bladder rupture in 1 case, a non-expanding zone 3 haematoma in 1 case, and a negative laparotomy in 1 case. Four (57%) patients were successfully managed without surgical interventions.
Conclusions: Isolated FF is uncommon and the clinical significance remains unclear. Provided that reliable serial physical examination can be performed by experienced surgeons, an initial non-operative approach should be considered. |
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