**2.4. CT scanning**

CT is noninvasive, qualitative, sensitive, and accurate for the diagnosis of intra-abdominal injury. Modern spiral scanners have greatly decreased the time required for obtaining high quality images. However, CT scanning remains expensive. CT scanning requires transport from the acute care area and should not be attempted in the unstable patient.

CT scanning has a primary role in defining the location and magnitude of intra-abdominal injuries related to blunt trauma. It has the advantage of detecting most retroperitoneal injuries, but it may not identify some gastrointestinal injuries. The formation provided on the magnitude of injury allows for nonoperative management of patients with solid organ injuries.

In the hemodynamically stable patient, CT scanning is an excellent diagnostic modality that is easy to perform. No diagnostic modality outperforms CT in the evaluation of intraperitoneal as well as retroperitoneal injuries (**Figure 2**).

### **2.5. Diagnostic peritoneal lavage**

Diagnostic peritoneal lavage (DPL) is designated to detect the presence of intraperitoneal blood, although its use has decreased significantly at many centers with the use of the FAST

**Figure 2.** A CT image in blunt abdominal trauma (liver laceration and intraperitoneal blood was shown with the landmarks such as the pancreas, spleen, and portal vein).

examination. Determinations of leucocytes, particulate matter, or amylase in the lavage fluid may indicate the presence of a bowel injury. Drainage of lavage fluid from a chest tube or urinary catheter may indicate a lacerated diaphragm or bladder. Lavage can be performed easily and rapidly, with minimal cost and morbidity. It is an invasive procedure that will affect the findings on physical examination, and it should be performed by a surgeon [3].

The procedure is neither qualitative nor quantitative. It cannot identify the source of hemorrhage, and relatively small amounts of intraperitoneal bleeding may result in a positive study.

Although DPL has largely been replaced by ultrasonography, it is still used occasionally. The main concern regarding DPL is that it is overly sensitive for intra-abdominal blood, which has led to a high rate of negative or nontherapeutic laparotomies [4].

If DPL is considered, it should be performed only after consultation with the trauma surgeon, who should perform this diagnostic study in most cases (**Table 1**).
