Gastrointestinal ❯ Trauma to Abdomen
| Problem | The evaluation of the abdomen following trauma. The trauma can range from a fall, to an MVA to a GSW to an altercation. Sometimes patients are “found down” and trauma is a consideration as well. The type of trauma and mode of injury usually can alert the Radiologists to the likelihood of specific injuries. |
| Protocol | Depending on the mode of injury the exact protocol will vary. In many cases a chest CT will also be obtained and in other cases scans thru the lower extremities will be done as well. For an abdominal focused exam water for gastric distension is ideal bur can’t always be done and may be eliminated especially in patients with concurrent brain trauma. Ideally a dual phase acquisition with arterial and venous phase imaging should be done. Delayed phase imaging may be necessary to look at the bladder but if bladder injury is suspected than a CT cystogram will be needed. Similarly in GSWs when bowel injury is suspected rectal contrast may be necessary. |
| Pearls | 1. Review of the study on an organ by organ basis is critical to look for splenic, liver or kidney injuries 2. In select cases of renal injury delayed phase imaging at 5 minutes is helpful to define injury to the renal pelvis or ureter 3. Bowel injury is often challenging especially in MVAs where the only sign may be some free fluid or minimal air that is extraluminal. Please look carefully 4. Arterial phase imaging may be best for detection active bleed in solid organs 5. Please review the abdomen even briefly with lung windows to detect even minimal air 6. Delayed phase imaging can not exclude bladder injury 7. Review of images with bone window is critical for detection of bone injury. Review of coronal and sagittal images is critical 8. Please review images thru the lower lung fields to exclude an unsuspected pneumothorax |