Abstract Objective: To determine if ultrasonography is useful in evaluating penetrating injuries of the trunk to assess whether violation of the peritoneum or pleura has occurred. Methods: The study group was 29 patients who suffered gunshot (n=17), stab (n=10), or shotgun (n=2) wounds. The abdomen was at risk in 21 injuries, the thorax in eight. The results of physical examination and plain x-rays suggested the pleura and or peritoneum might be intact in all patients. Using a 7-MHZ transducer, wound tract(s) were imaged, looking for the presence of soft-tissue air and/or echolucent areas consistent with soft-tissue blood. Injuries were deemed extraperitoneal or extrapleural if (1) the entire tract was visualized; (2) it appeared superficial to the deepest fascial structure in that area; and (3) in shotgun injuries, all visible pellets on x-ray films were identified by ultrasound in the abdominal wall. Results: Evidence of penetration occurred in four abdominal wounds and one thoracic wound. These were confirmed by operation in the abdominal cases and by subsequent chest x-ray examination in the one thoracic wound. The diagnosis of nonpenetration was confirmed in all the remainder by serial benign abdominal examination (n=15), chest x-ray examination (n=8), and laparoscopy (n=1). Positive and negative predictive accuracy were thus 100% in this pilot series. Conclusions: Ultrasonographic exploration of penetrating truncal injuries is feasible and accurate. Ultrasonographic wound exploration may serve as a noninvasive and safe replacement for diagnostic laparoscopy, conventional local wound exploration, peritoneal lavage, and 6-hour chest x-rays (repeated chest x-rays taken 6 hours after initial chest x-ray examination). If used as part of the initial physical examination, cost-effectiveness can also be realized.(Arch Surg. 1995;130:605-608) References 1. Thal ER. Evaluation of peritoneal lavage and local wound exploration in lower chest and abdominal wounds . J Trauma. 1977;12:642-648.Crossref 2. Nance FC, Wennar MH, Johnson LW, Ingram JC Jr, Cohn I Jr. Surgical judgement in the management of penetrating wounds of the abdomen . Ann Surg. 1974;179:639-646.Crossref 3. Smith RS, Fry WR. Alternative techniques in laparoscopy for trauma . Trauma Q . 1994;10:291-300. 4. Ivatury RR, Simon RJ, Stahl WM. A critical evaluation of laparoscopy in penetrating abdominal trauma . J Trauma . 1993;34:822-828.Crossref 5. Weigelt JA, Aurbakken CM, Meier DE, Thal ER. Management of asymptomatic patients following stabwounds to the chest . J Trauma . 1982;22:291-294.Crossref 6. Smith RS, Tsoi EKM, Fry WR, et al. Laparoscopy is cost effective in the evaluation of abdominal trauma . Surg Endosc . 1993;7:137.Crossref 7. Wyatt GM, Spitz HB. Ultrasound in the diagnosis of rectus sheath hematoma . JAMA . 1979;241:1499-1500.Crossref 8. Rozycki GS, Ochsner MG, Frankel HL, et al. A prospective study of surgeon performed ultrasound as the initial diagnostic modality for injured patient assessment. Presented at the meeting of the American Association for the Surgery of Trauma; September 30, 1994; San Diego, Calif.
Archives of Surgery – American Medical Association
Published: Jun 1, 1995