Multi detector computed tomography imaging in penetrating injuries

Namrita Sachdev, Yashvant Singh, Sana ., Dipshi Mehta


Background: Penetrating injuries forms an important component of surgical emergencies. Penetrating trauma typically involves the violation of the body by a gunshot wound (GSW) or stab wound. Emergency laparotomy is the accepted management in patients with a penetrating injury who are not hemodynamically stable. However, selective non-operative management has been shown to decrease the rate of unnecessary surgery. Plain radiographs and FAST are useful for initial assessment of these patients. Multi detector CT is an indispensable tool in the evaluation of patients who are stable and are candidates for conservative treatment.

Methods: A cross sectional observational study was carried out on 40 patients admitted with penetrating injury to the trauma centre of PGIMER and Dr RML hospital. Of the 40 patients, 14 were taken for emergency laparotomy. In 26 cases, MDCT was done to evaluate for solid organ, hollow organ and vascular injuries.

Results: The mean age of patients was 38 years, with male to female ratio of 5:1. Stab injury was the commonest type of injury, followed by gunshot wounds. Liver was the commonest solid organ involved, followed by kidneys and spleen. Other organs involved were diaphragm, small bowel and colon.

Conclusions: Penetrating injuries can be life-threatening, making prompt diagnosis essential. Recognizing key abnormalities on MDCT ensures patients are triaged appropriately. Multi-detector CT is thus widely used to evaluate penetrating injuries in stable patients.


Gunshot wounds, Multi detector computed tomography, Penetrating injury, Stab injury

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Inaba K, Demetriades D. The nonoperative management of penetrating abdominal trauma. Adv Surg. 2007;41:51-62.

Demetriades D, Velmahos GC. Indications for and techniques of laparotomy. In: Feliciano DV, Mattox KL, Moore EE, eds. Trauma, 6th ed. New York, NY: McGraw-Hill; 2008:607-622.

Jenkins D, Dougherty P. The effects of bullets. In: Mahoney PF, Ryan JM, Brooks AJ, Schwab CW, eds. Ballistic trauma. London, England: Springer; 2005:40-44.

Stapley SA, Cannon LB. An overview of the pathophysiology of gunshot and blast injury with resuscitation guidelines. Curr Orthop. 2006;20(5):322-32.

Conrad MF, Patton JH, Parikshak M, Kralovich KA. Selective management of penetrating truncal injuries: is emergency department discharge a reasonable goal? Am Surg. 2003;69(3):266-72.

Mitra B, Gocentas R, O’Reilly G, Cameron PA, Atkin C. Management of haemodynamically stable patients with abdominal stab wounds. Emerg Med Australas. 2007;19(3):269-75.

Folio LR, Fischer TV, Shogan PJ, Frew MI, Kang PS, Bunger R, et al. CT based ballistic wound path identification and trajectory analysis in anatomic ballistic phantoms. Radiol. 2011;258(3):923-9.

Demetriades D, Hadjizacharia P, Constantinou C, Brown C, Inaba K, Rhee P, et al. Selective nonoperative management of pen-etrating abdominal solid organ injuries. Ann Surg. 2006;244(4):620-8.

Bondia JM, Anderson SW, Rhea JT, Soto JA. Imaging colorectal trauma using 64-MDCT technology. Emerg Radiol. 2009;16(6):433-40.

Murray JA, Demetriades D, Asensio JA, Cornwell III EE, Velmahos GC, Belzberg H, et al. Occult injuries to the diaphragm: prospective evaluation of laparoscopy in penetrating injuries to the left lower chest. J Am Coll Surg. 1998;187(6):626-30.

Murray JA, Demetriades D, Cornwell EE, Asensio JA, Velmahos G, Belzberg H, et al. Penetrating left thoracoabdominal trauma: the incidence and clinical presentation of diaphragm injuries. J Trauma. 1997;43(4):624-6.

Shanmuganthan K, Scalea TM. Imaging of penetrating trauma of the torso and chest. In: Mirvis SE, Shanmuganathan K, eds. Imaging in trauma and critical care. 2nd ed. Philadelphia, Pa: Saunders; 2003:633-696.

Goodman CS, Hur JY, Adajar MA, Coulam CH. How well does CT predict the need for laparotomy in hemodynamically stable patients with penetrating abdominal injury? A review and meta-analysis. Am J Roentgenol. 2009;193(2):432-7.

Lozano JD, Munera F, Anderson SW, Soto JA, Menias CO, Caban KM. Penetrating wounds to the torso: evaluation with triple contrast multidetector CT. Radio Graphics. 2013;33(2):341-59.