A person presents with severe abdominal trauma but was found to be hemodynamically stable on examination. Investigation of choice for this patient is:
Ans: D (CT abdomen) Ref: Schwartz Textbook of Surgery, 10th edition, pg: 181Explanation:"Computed tomography is the investigation of choice in haemodynamically stable patients with abdominal trauma Ref: Recent Advances in Surgery 32, Irving Taylor, pg: 106"In patients who are hemodynamically stable. CT is the investigation of choice for assessment of the injured abdomen.'' Ref: Trauma Care Manual, 2nd edition, By Ian Greaves, pg: 151CT AbdomenIt is very sensitive for free fluid and solid organ injury but less for small viscus perforations.It can simultaneously detect injury to the spine or pelvis. Focused Assessment with Sonography in Trauma )it is part of primary survey and it can be done during the initial assessment without moving the patient to the radiology suite.The FAST images the pericardium, right and left upper quadrants and pelvis.Its primary aim is to find abnormal pericardial fluid or intraperitoneal free fluid.Unstable patients with FAST showing free fluid in abdomen should be taken up for emergency laparotomyFAST is poor at detecting viscus perforation, and is limited in obese patients and in patients with subcutaneous emphysema.Diagnostic Peritoneal LavagePeritoneal dialysis catheter is placed though the abdominal wall near the umbilicus into the pelvic/peritoneal cavity.Aspiration of blood is considered positive for abdominal injury.DPL has low specificity in identifying many lesions that do not require operative repair and thus resulting in a high negative laparotomy rate.DPL also m/sses retroperitoneal injuries.Erect X-ray AbomenCan diagnose air under the diaphragm which denotes hollow viscus injury.Investigation of ChoiceAbdominal trauma in hemodynamically stable patientsCT abdomenAbdominal trauma in hemadynamically unstable patientsLaparotomyMultisystem injury where abdomen is only one of the potential sources of cardiovascular instabilityFAST or DPL
Diagnostic peritoneal lavaae
FAST
Erect X-ray abdomen
CT abdomen
Abdominal Injury