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Journal of Trauma and Injury 2014;27(4):145-150.
The Role of Single-contrast CT for Management in Hemodynamically Stable Anterior Abdominal Stab wound Patients
Janghwan Jo, Joongsuck Kim, Yeongcheol Kim, Ilyong Chung, Jongmin Park, Eunjung Ahn, Eunyoung Kim, Seihyeog Park, Seongyup Kim
1Department of Surgery, National Medical center, Seoul, Korea.
2Trauma center, National Medical center, Seoul, Korea. snoopy4936@naver.com
혈역학적으로 안정된 복부 전벽 자상 환자의 개복 수술 결정에서 Single-contrast CT의 역할
조장환, 김중석1, 김영철1, 정일용1, 박종민, 안은정, 김은영, 박세혁, 김성엽1
국립중앙의료원 외과, 1외상센터
Received: 21 August 2014   • Revised: 21 October 2014   • Accepted: 21 October 2014
Abstract
PURPOSE
To assess the accuracy and role of single-contrast computed tomography (CT) in the management of anterior abdominal stab wound (AASW).
METHODS
During 8-years period, single-contrast CT was performed in 21 hemodynamically stable AASW patients (age range, 22-64 years; median age, 45 years), including 19 men and 2 women. CT scans were evaluated by one trauma surgeon and one senior resident to determine the depth of injury(peritoneal violation or not), and abnormal findings of intraperitoneal cavity associated with stab injury. We retrospectively reviewed medical records regarding operative findings.
RESULTS
Nine patients underwent abdominal surgery and 12 patients nonoperative management. In the abdominal surgery group, abnormal CT findings included peritoneal violation in 14 patients and abnormal intraperitoneal cavity findings in 5 patients. There was no statistical significant difference regarding abnormal CT findings between abdominal surgery group and nonoperative management group. Among the nine abdominal surgery patients, therapeutic laparotomy was performed on 4 patients. The positive predictive value (PPV) and negative predictive value (NPV) of peritoneal violation to predictive therapeutic laparotomy were 28.6% and 100%, respectively. In addition, the PPV and NPV of abnormal intraperitoneal cavity CT findings to predict therapeutic laparotomy were 40.0% and 87.5%, respectively. There was no statistical significant difference regarding the abnormal CT findings between therapeutic laparotomy group and non therapeutic laparotomy group.
CONCLUSION
CT is a good adjunctive method to evaluate hemodynamicaly stable AASW patients. If peritoneal violation is not seen on CT scan, conservative treatment on local wound may be safely performed without additional abdominal surgery. However, further study is warranted to evaluate the exact role of CT in the diagnostic workup of AASW patients.
Key Words: Wounds; Stab; Abdomen; Tomography; X-Ray Computed


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