Recent Advancer in the Diagnosis of Abdominal Trauma

Toshifumi Otsuka

Department of Emergency and Critical Care Medicine, Nippon Medical School

Diagnosis of abdominal trauma progressed rapidly during the 1980's because of the development of computed tomography (CT) and ultrasonography (US). US has several advantages, not only detecting the hemoperitoneum but also showing the site and grade of the solid visceral injury noninvasively and repeatedly. CT reveals parenchymal injury such as to the liver, spleen and kidney objectively and clearly. Moreover it can detect a small amount of free intraperitoneal or retroperitoneal air and intraabdominal fluid. On the other hand, diagnostic peritoneal lavage (DPL) had been disregarded in Japan since its false positive rate seemed to be quite high. But we overcame this problem by adopting new diagnostic criteria. In the case of multisystem trauma, delayed or missed diagnosis of an occult abdominal injury results in a serious outcome. Therefore it is important to use DPL aggressively. Progress in diagnostic imaging has brought us the increased possibility of nonoperative management of solid viscus injury. However, we should pay more attention to avoiding delayed diagnosis than to avoiding unnecessary laparotomy by using many diagnostic modalities.

Key words
abdominal trauma, diagnostic imaging, diagnostic peritoneal lavage

Reprint requests
Toshifumi Otsuka Department of Emergeacy and Critical Care Medicine, Nippon Medical School
1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113 JAPAN

Accepted
October 7, 1992

To read the PDF file you will need Abobe Reader installed on your computer.