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Gunshot Wounds of Abdomen: Evaluation of Stable Patients with Triple-Contrast Helical CT¹

¹ From the Departments of Radiology (F.M., J.A.S., T.S., V.G., G.V.), Surgery, Division of Trauma Surgery (C.M., M.C.), and Epidemiology and Biostatistics (H.I.G.), Universidad de Antioquia, Hospital Universitario San Vicente de Paúl, Medellín, Colombia. From the 2002 RSNA scientific assembly. Received January 7, 2003; revision requested March 14; final revision received August 15; accepted September 29. Address correspondence to F.M., Department of Radiology, West Wing 279, University of Miami School of Medicine, Jackson Memorial Hospital/Ryder Trauma Center, 1611 NW 12th Ave, Miami, FL 33136 (e-mail: fmunera@med.miami.edu).

PURPOSE: To assess helical computed tomography (CT) with contrast material administered intravenously, orally, and rectally (triple contrast helical CT)) in the prospective evaluation of stable patients with abdominal gunshot wounds in whom there is no clinical indication for immediate exploratory laparotomy.

MATERIALS AND METHODS: The study was conducted for 19 months. All patients met the following inclusion criteria: age of 16 years or older, hemodynamic stability, no clinical signs of peritoneal irritation, and signed consent to participate. Patients with obvious indications for laparotomy, such as gastrointestinal bleeding or evisceration, were excluded from the study. Forty-seven patients fulfilled the criteria and underwent abdominal triple-contrast helical CT. CT findings were evaluated by one of four radiologists for evidence of peritoneal penetration and injury to solid organs or hollow viscera. Patients were followed up clinically for 13 weeks. CT findings were compared with those at surgery and/or clinical follow-up.

RESULTS: CT demonstrated abnormalities in 27 (57%) patients. Laparotomy was performed in 11 (23%) patients; 10 procedures were therapeutic and one was nontherapeutic. The remaining 20 patients had a negative CT scan. These patients were treated conservatively. One injury was missed at CT. For prediction of the need for laparotomy, sensitivity of CT was 96%; specificity, 95%; positive predictive value, 96%; negative predictive value, 95%; and accuracy, 96%.

CONCLUSION: In stable patients with gunshot wounds to the abdomen in whom there is no indication for immediate surgery, triple-contrast helical CT can help reduce the number of cases of unnecessary or nontherapeutic laparotomy (negative laparotomy) and can help identify patients with injuries that may be safely treated without surgery.

© RSNA, 2004

Index terms: Abdomen, CT, 70.12115 • Abdomen, injuries, 70.41 • Computed tomography (CT), clinical effectiveness, 70.12115 • Gunshot injuries, 70.41 • Trauma, 70.41

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