The Radiologic Differential Diagnosis of Abdominal Trauma

Abstract

In the past twelve years 217 consecutive patients with abdominal injuries have been admitted to the operating rooms of the Los Angeles County Harbor General Hospital. In 198 of these patients roentgen examinations were performed prior to surgery. One hundred and fifty-nine of these roentgen examinations were available for review. Method of study Clinical records and roentgenograms were reviewed in all of the cases. Information on the following points was recorded, when available, for each case: age and sex of patient; type of trauma (penetrating or nonpenetrating); history and physical findings; the highest recorded white blood cell count prior to surgery; presence or absence of hematuria; the findings on four quadrant taps; the finding of intra-abdominal fluid at surgery; roentgen evidence of fluid, enlarged spleen, or left upper quadrant density; size of the liver shadow; localized or generalized ileus; pneumoperitoneum; retroperitoneal hematoma; pleural effusion; elevation of the diaphragm; fractures of ribs, transverse processes, and pelvis; operative findings. General Observations Distribution of Sites of Injury: One hundred and thirteen patients had nonpenetrating injuries and one hundred and four had penetrating injuries. In 167 cases there was only one major site of injury, while in 50 patients multiple major sites were involved. Multiple involvement was more frequent following penetrating trauma. The commoner sites of injury were the spleen, abdominal wall, small intestine, liver, bladder, and kidney. Many kidney injuries are not included in the series studied, as no exploration was done. If clinical diagnosis had been accepted as the basis for comparison, there is no doubt but that the kidney would be the most frequently encountered site. Table I tabulates the injuries by site and type of trauma.