**2.2. Plain radiography**

Almost all major trauma patients require plain X-rays of the chest, pelvis, and cervical spine. Although rarely used today because of the ubiquity of computed tomography (CT) scanning, a one-shot intravenous pyelogram may be useful in patients with flank wounds or gross hematuria who are unable to undergo further diagnostic testing prior to operative intervention.

### **2.3. Ultrasonography**

Ultrasonography has emerged as the primary initial diagnostic examination of the abdomen in multisystem injured blunt trauma patients. Emergency ultrasonography has been studied extensively and is rapid and accurate in the identification of intraperitoneal free fluid. Also, it is safe in special patient populations (e.g., pediatrics, obstetrics). Focused assessment with sonography for trauma (FAST) examination is a bedside test that has demonstrated good accuracy with relatively minimal operator experience. In the standard FAST examination, four areas are scanned: the right upper quadrant, the subxiphoid area, the left upper quadrant, and the pelvis. Unstable patients with a positive FAST examination should undergo urgent exploratory laparotomy [1]. Unlike CT, a FAST examination is rapid, can be performed bedside in the emergency department, and is easily repeatable [2] (**Figure 1**).

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

**Figure 2.** A CT image in blunt abdominal trauma (liver laceration and intraperitoneal blood was shown with the

Abdominal Trauma

79

http://dx.doi.org/10.5772/intechopen.76474

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 Although DPL has largely been replaced by ultrasonography, it is still used occasionally.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

If DPL is considered, it should be performed only after consultation with the trauma surgeon,

Laparoscopy has an important role in stable patients with penetrating abdominal trauma. It can quickly establish whether peritoneal penetration has occurred and thus reduce the number of negative and nontherapeutic trauma laparotomies performed [5]. Laparoscopy has also been applied safely and effectively as a screening tool in stable patients with blunt abdominal

The use of laparoscopy, with or without CT scanning or DPL, is being studied. It is less invasive than traditional laparotomy and may shorten hospital stays and decrease patient costs,

findings on physical examination, and it should be performed by a surgeon [3].

led to a high rate of negative or nontherapeutic laparotomies [4].

who should perform this diagnostic study in most cases (**Table 1**).

although it requires surgical consultation [7].

landmarks such as the pancreas, spleen, and portal vein).

**2.6. Laparoscopy**

trauma [6].

**Figure 1.** Transducer positions for FAST: pericardial area, right and left upper quadrants, and pelvis.
