THE ROLE OF ONE-SHOT INTRAVENOUS PYELOGRAM IN EVALUATION OF PENETRATING ABDOMINAL-TRAUMA

The role of limited ''one-shot'' intravenous pyelogram (IVP) in patien ts sustaining proximity penetrating trauma is not well defined, althou gh formal IVP remains the ''gold standard'' for evaluating possible ur ological injuries. This retrospective review evaluates the efficacy an d usefulness of limited one-shot IVP in penetrating abdominal trauma p atients who are suspected of having urological injuries. The charts of 40 patients with penetrating abdominal trauma who had one-shot IVP pe rformed in the emergency room at presentation were reviewed. Of the to tal, 36 patients had gunshot wounds and only 4 patients had stab wound s. Mean Penetrating Abdominal Trauma Index was 15.7, with 47.5 per cen t of patients in shock. Only 2 out of 10 urological injuries were dete cted by one-shot IVP. The positive predictive value of limited one-sho t IVP was only 20 per cent, with sensitivity 25 per cent and specifici ty 76.2 per cent. The results of the one-shot IVP did not influence th e decisions for laparotomy in any of the 35 (87.5%) patients who under went exploratory laparotomy. In the two patients with positive one-sho t IVPs who had urological injuries, the decision to operate was again determined by the presence of other associated intra-abdominal injurie s. Eighty per cent of patients with normal one-shot IVP findings had r enal injuries not detected by one-shot IVP, and 20 per cent of patient s with abnormal IVP findings had no intraoperative evidence of renal i njury. The presence of gross hematuria appeared to correlate with the presence of significant urological injuries. We therefore conclude tha t limited one-shot IVP is of no significant value in assessing penetra ting abdominal trauma patients who subsequently undergo exploratory la parotomy for other associated intra-abdominal injuries, and indeed, th e delay imposed, before definitive operative intervention in potential ly unstable patients, is unjustified.