Computer tomography (CT) scan is a valuable tool for evaluating a patient with abdominal injury, especially when done in conjunction with a focused abdominal sonographic (FAST) or diagnostic peritoneal lavage (DPL).



(1) CT scan unit readily accessible

(2) trained operators

(3) patient hemodynamically stable or responsive to resuscitation

(4) physiologic monitoring available

(5) resuscitation equipment available in CT suite


FAST or DPL problems:

(1) previous abdominal surgery

(2) pregnancy in second or third trimester

(3) coagulopathy (false positive DPL)

(4) technically inadequate FAST or DPL


FAST or DPL findings:

(1) positive FAST or DPL

(2) negative FAST or DPL with abdominal pain and/or guarding

(3) negative FAST or DPL with unexplained decline in hemoglobin and hematocrit


Occult injury likely:

(1) pelvic fractures

(2) lumbar and lower thoracic vertebral injuries

(3) gross hematuria

(4) retroperitoneal injury suspected

(5) injury to liver, spleen or kidney suspected

(6) gunshot wound tangential or to back (celiotomy indicated if direct to abdomen)

(7) automobile accident with seat belt sign


Other considerations:

(1) CT scans required of other body regions

(2) unreliable clinical examination


When a CT scan may not be appropriate:

(1) unstable or rapidly deteriorating condition

(2) obvious intra-abdominal injury (direct gunshot wound, etc.) requiring immediate attention

(3) uncooperative or constantly moving patient


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