The role of computed tomography in selective management of gunshot wounds to the abdomen and flank

Objective: To determine whether computed tomography (CT) is an accurate dia gnostic modality for the triage of hemodynamically stable patients with gun shot wounds of the abdomen and Bank. Methods: A chart review of 83 trauma patients for whom abdominal CT was use d as initial screening. Results: In 53 patients, CT revealed no evidence of peritoneal penetration, and in 15 patients, there was evidence of either peritoneal penetration or liver injury. There were no false results in these patients. Among 15 pati ents with questionable peritoneal penetration, cavitary endoscopy was perfo rmed in 11 and exploratory laparotomy was performed in 3, and 1 patient was initially observed and subsequently underwent exploratory surgery for a mi ssed colonic injury. Conclusion: In selected centers and in hemodynamically stable patients with abdominal and flank gunshot wounds, abdominal CT can be an effective and s afe initial screening modality to document the presence or absence of perit oneal penetration and to manage nonoperatively stable patients with liver i njuries. If there is any question of peritoneal penetration, cavitary endos copy should be part of the protocol of nonoperative management.