Type:
Educational Exhibit
Keywords:
Trauma, Acute, Diagnostic procedure, CT, Thorax, Abdomen
Authors:
C. E. Jenkins, R. Ellis Owen, C. Parry, A. Marin, A. Eynon; Cardiff/UK
DOI:
10.1594/ecr2018/C-1804
Background
Penetrating abdominal or thoracic trauma from stabbing can cause significant injury.
CT plays an important role in the initial assessment and follow-up of penetrating trauma in haemodynamically stable patients.
The management of unstable patients with evidence of a stab wound should however not be delayed by CT and exploratory laparotomy remains the gold standard in this cohort.
Multidetector CT is used to determine which haemodynamically stable patients should proceed to immediate surgery and which can be treated conservatively.
Prior to CT review it is important to obtain an accurate clinical history.
The type of weapon used,
in particular its length and width,
the number and site of wounds and the position of the patient during the stabbing should be ascertained.
When reviewing the CT it is important to remember that the site of the external surface wound does not always correlate with the internal injuries.
Organs such as the diaphragm,
colon and small bowel are mobile and may lie in different locations within the torso at various times and patient positions.
CT can help identify the injury track in addition to any primary or secondary signs of organ injury.
Signs that should raise the suspicion of peritoneal penetration include:
- A wound track (in combination with haemorrhage,
air or bone fragments)
- Free gas or fluid
- Solid organ injury
- Intravenous contrast blush suggestive of vascular injury
Historically,
triple contrast CT (intravenous,
rectal and oral contrast) was used in cases of penetrating trauma; in our institution a pre-contrast CT thorax,
abdomen and pelvis followed by a multiphase IV contrast CT thorax,
abdomen and pelvis is performed using a biphasic type protocol (arterial and portal venous phase combined following split bolus administration of the IV contrast).
In the assessment of wound tracks,
in particular those that are obliquely orientated,
reconstructed images are particularly helpful.
We present a selection of cases of both intentional and accidental stab wounds sustained as a result of either domestic or urban violence.