Patients with minimal free fluid and no abdominal tenderness can be observed, while patients with moderate-large amounts of free fluid and abdominal tenderness should undergo operative exploration.
To determine if operative exploration or observation is the preferred management for hemodynamically stable blunt trauma patients with isolated free fluid on abdominal computed tomography (CT) imaging, researchers reviewed the management and outcomes for 156 such patients admitted to a level 1 trauma center in California from 2009 to 2012. All patients were 16 years or older and had no peritoneal signs on examination, no evidence of solid organ or hollow viscous injury on CT imaging, and no history of cirrhosis.
Most patients (91%) were successfully managed nonoperatively. Ten patients underwent immediate operative exploration and were diagnosed with intraperitoneal bladder injury (4), ruptured ovarian cyst (1), mesenteric laceration (1), mesenteric hematoma (1), splenic laceration (1), and pancreatic injury (1); the operation was nontherapeutic in one patient. Four patients failed nonoperative management and had small bowel perforations diagnosed intraoperatively. The presence of a moderate to large amount of free fluid and abdominal tenderness predicted the need for surgical intervention (positive predictive value, 62%).
The HPC Hospital and Emergency Procedures CME course qualifies for 16 hours of Trauma CMEbecause we help to train emergency room physicians and midlevel providers how to initially stabilize the acutely injured patient.
Gonser-Hafertepen LN et al. Isolated free fluid on abdominal CT in blunt trauma: Watch and wait or operate? J Am Coll Surg 2014 Jun 5 (epub ahead of print)