Original Article / Liver
Incidence of unexplained intra-abdominal free fluid in patients with blunt abdominal trauma Zuo-Bing Chen, Yun Zhang, Zhong-Yan Liang, Shao-Yang Zhang, Wen-Qiao Yu, Yuan Gao and Shu-Sen Zheng Hangzhou, China
BACKGROUND: Intra-abdominal free fluid is commonly caused by injuries of solid or hollow organs in patients suffering from blunt abdominal trauma (BAT). However, it presents a diagnostic dilemma for surgeons when free fluid is unexplained, especially in stable BAT patients. This study was to analyze the incidence of such unexplained free fluid in BAT patients and its diagnostic value in abdominal organ injury. METHODS: Altogether 597 patients with BAT who had been treated at our trauma center over a 10-year period were reviewed. Stable patients with free fluid but without free air or definite organ injury on abdominal computed tomography were studied. Clinical management and operative findings were analyzed. RESULTS: Thirty-four (5.70%) of the 597 patients met the inclusion criteria: 24 (4.02%) underwent therapeutic exploratory laparotomy: bowel injuries were found in 13, hepatic rupture in 3, colon rupture in 3, duodenal rupture in 2, spleen rupture in 1, pancreas rupture in 1, and gallbladder perforation in 1. In 2 patients, laparotomy was nontherapeutic. Those with moderate or large amounts of free fluid were more likely to suffer from a hollow viscus injury and have a therapeutic procedure. The mean time of hospital stay for the delayed laparotomy group was longer than that for the emergency group (19±5.12 vs. 12±2.24 days; t=2.73, P14; and no potentially fatal craniocerebral or thoracic injury. The data from all eligible patients (24 males and 10 females; mean age 32 years) were divided into two groups according to the initial treatment plan made by the trauma surgeon: one for those who underwent emergency exploratory laparotomy, and the other for those who were observed for at least 24 hours. Some observed patients were given delayed
laparotomy after 24 hours due to a rapid increase in the volume of free fluid, unstable hemodynamics, marked peritoneal irritation, the defined source of free fluid, or intra-abdominal free air. On admission all patients underwent CT scanning on a helical CT scanner with 10-mm cuts through the abdomen and pelvis. All abdominal CT scans with free fluid were reviewed by a radiology resident and the trauma team. The quantity of free fluid was graded as trace, moderate, or large. A trace amount of fluid was defined as fluid seen on one to three CT sections; a moderate amount of fluid was seen on four to five contiguous sections or consisting of two separate collections of a trace amount of fluid, and a large amount of fluid was seen on more than five contiguous CT sections, or a combination of the trace and moderate amounts of fluid in two or more locations, as described by others.[4, 12] The relation between the volume of intraabdominal free fluid and the findings of operation, the incidence of complications, and the percentage of therapeutic operations were assessed. Statistical analysis was performed for discrete variables using Student's t test. P
