Wednesday, August 8, 2012
MDCT is routinely used in the evaluation of blunt abdominal trauma. The presence of intraperitoneal free fluid in the absence of identifiable injury presents a diagnostic challenge, especially in male patients (in female patients, free fluid, especially when seen in the pouch of Douglas, can be a normal physiologic finding).
In the late 1990s the presence of free fluid without identifiable injury necessitated exploratory laparotomy. Since then, studies have advocated for conservative management such as admitting the patient for observation rather than proceeding with surgical intervention.
In their study of 669 consecutive male trauma patients, Drasin and Anderson show that approximately 3% of patients can have the finding of isolated free fluid without clinical significance They advocate for the evaluation of factors such as size and attenuation measurements of fluid when triaging the patient and suggest that observation with repeat imaging may prevent unnecessary laparotomies.
Drasin TE, Anderson SW, Asandra A, et al. MDCT evaluation of blunt abdominal trauma: clinical significance of free intraperitoneal fluid in males with absence of identifiable injury. AJR Am J Roentgenol 2008;191:1821-26.
Levin CD, Patel UJ, Wachsberg RH, et al. CT in patients with blunt abdominal trauma: clinical significance of intraperitoneal free fluid detected on a scan with otherwise normal findings. AJR Am J Roentgenol 1995;164:1381-85.