نقش روشهاي تشخيصي (سونوگرافي و لاواژ تشخيصي صفاق ) در بيماران دچار تروماي غير فاقد شكم (بررسي 5 ساله )

ROLE OF DIAGNOSTIC TOOLS (SONOGRAPHY & DPL) IN BLUNT ABDOMINAL TRAUMA (A 5 YEARS REPORT)

Introducton: Blunt abdominal trauma is one of the most common mechanisms of trauma especially in motor vehicle accidents. Diagnostic problems are the matter of concern in these patients. There are many reports about the accuracy of diagnostic tools considering the decrease in the rate of negative laparotomies at the same time. Materials and methods: In this study all emergency laparotomies of a referral hospital are evaluated in a 5 years period retrospectively (1996-2000). Results: There were 61 positive and 14 negative (18.7%) laparotomies in 75 patients. 4 patients underwent nontherapeutic laparotomy because of retroperitoneal hematoma. Sonography was done in 34 cases with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) as 84.3%, 50%, 96.4% and 16.6%, respectively. Diagnostic peritoneal lavage (DPL) which was done for 16 patients had 100% sensitivity, 66.7% specificity, 92.8% PPV and 100% NPV. There were 9 negative laparotomies (32.2%) in 28 patients whom were operated on the basis of clinical findings merely. Disscussion: We concluded that sonography is a valuable tool for initial assessment of blunt abdominal trauma. Of course, more accurate tests should be in mind whenever clinical findings are incompatible with sonographic data, considering its low specificity and NPV. DPL still, is a safe and accurate method for evaluating blunt abdominal trauma victims. Laparotomy without any diagnostic procedure yields more negative results.