Value of complementary investigations in the diagnosis and treatment of penetrating abdominal trauma.

There is persistent controversy concerning the management of patients with abdominal trauma. The major point is to determine whether or not the abdomi nal trauma is penetrating. In rare cases (shock, abdominal gunshot wound, p eritonitis, evisceration, digestive tract bleeding and abdominal stab out o f place) urgent laparotomy remains mandatory. In the other cases, although some centers recommend serial abdominal exams for asymptomatic patients, wi th the risk of delayed laparotomy, most authors prefer a more aggressive ap proach. In the case of anterior penetrating abdominal trauma, diagnostic pe ritoneal lavage, which is an over sensitive method, could be replaced by la paroscopy, which allows both diagnosis and treatment. Triple-contrast CT sc an is the first-line diagnostic modality in penetrating back and flank trau ma.