Role of MDCT in the Evaluation of Blunt Abdominal Trauma in Himalayan Region of Northern India

Introduction: Blunt abdominal trauma is a major cause of morbidity and mortality in young people. Abdominal Ultrasonography (USG) can detect organ injury and free intraabdominal fluid which provides indirect evidence of injury. Multidetector Computed Tomography (MDCT) is the modality of choice in haemodynamically stable patients as it can accurately diagnose and ascertain the severity of injuries. It can also evaluate retroperitoneum and detect arterial contrast extravasation or pseudoaneurysm which predicts the need for surgery or angioembolisation. Aim: To study the spectrum of abdomino-pelvic injuries on MDCT and to compare the MDCT findings with operative findings wherever possible. Materials and Methods: The prospective cohort study was conducted in the Department of Radiodiagnosis at Indira Gandhi Medical College, Shimla, Himachal Pradesh, India, from the period 1st June 2019 to 31st May 2020. Patients with history of Road Traffic Accidents, fall, or assault or other causes where clinically blunt trauma of abdomen was suspected and referred for MDCT abdomen and pelvis were included. The blunt abdominal patients who were Focused Assessment with Sonography for Trauma (FAST) positive or had clinical suspicion of abdomino-pelvic injury were evaluated with MDCT. The present study was conducted on 64 slice MDCT scanner light speed Volume Computed Tomography Xte General Electrics (VCT Xte GE) medical systems. All patients underwent CECT abdomen and pelvis in arterial (30 seconds) and porto-venous phase (60 seconds). The MDCT findings were compared with operative findings and clinical follow-up was done after three months. Data were entered into Microsoft Excel sheet and Statistical Package for the Social Sciences (SPSS) software 20.0 version was used for analysing data. Results: Thirty five haemodynamically stable patients with blunt abdominal trauma were included in the study with mean age of 28.5 +/- 8.8 years with male predominance. Road traffic accident was the most common mechanism of injury. Visceral injury or free fluid was seen in all the 35 patients on MDCT of abdomen and pelvis. Twenty eight patients were managed conservatively while seven patients were operated. Solid organ injury was seen in 28 patients. Amongst solid organ injury, spleen was the most common organ injured followed by liver. On comparing MDCT and operative findings, pancreatic transection was found in three patients. Sigmoid perforation, renal injury and UB perforation were confirmed in one patient each. On comparing with surgical findings, MDCT had a sensitivity of 100%, specificity of 100% for detecting solid organ injury and the Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were 100% and 100%, respectively. Amongst hollow visceral injury, jejunal perforation was seen in two patients while ileal perforation and Urinary Bladder (UB) perforation was seen in one patient each. However, one case of sigmoid perforation was missed on MDCT. On comparing with surgical findings, MDCT has a sensitivity of 66.66%, specificity of 100% for detecting hollow visceral injury and the PPV and NPV were 100% and 80%, respectively. Conclusion: MDCT is helpful in detecting solid organ injuries. MDCT plays a major role in the management of blunt abdominal trauma and helps in making decision regarding operative and non operative treatment. Therefore, MDCT is the investigation of choice in patients with blunt abdominal trauma.