Prognosis of blunt abdominal trauma patients with contrast medium extravasation on computed tomography scan

Introduction

Until now there have been few studies concentrating on the diagnostic and prognostic significance of contrast medium extravasation site computed tomography (CT). In this study we investigated the site and extent of contrast medium extravasation on CT findings and its effect on treatment and predicting clinical outcome in trauma patients.

Methods

Fifty patients admitted to our emergency department with blunt abdominal trauma showing contrast medium extravasation on abdominal–pelvic CT scan were included in our study for 33 months. Patients were prospectively collected and medical records were reviewed and analyzed retrospectively. The patients' clinical and laboratory findings, abdominal sonographic (FAST) findings, and CT findings were reviewed. Extravasation sites were classified as intraperitoneal, retroperitoneal, intrapelvic and correlated with post-treatment complications, mortality and morbidity rates.

Results

The incidence of extravasation site was intraperitoneal in 33 cases (66%), retroperitoneal in 13 cases (26%), and intrapelvic in four cases (8%). The frequency of injured vessels showing extravasation was 18 (36%) hepatic vessels, nine (18%) splenic vessels and six (12%) iliac vessels. There was no correlation between the extravasation site and ICU or total hospitalization duration (P > 0.523). Sixteen patients with intraperitoneal extravasation required surgical intervention, six patients underwent angiography with embolization. In patients with retroperitoneal extravasation, nine were treated conservatively and two with embolization. Over all there were no significant differences between the extravasation site and treatment modality. The intraperitoneal group had the highest mortality with 13 deaths (11/33, 39%) and the highest early mortality rate (10/13, 76%) in the first 24 hours (P = 0.001).

Conclusion

CT findings in patients with blunt abdominal trauma showed no significant correlation between the contrast medium extravasation site and treatment modality, ICU hospitalization duration, or final results. However, patients with intraperitoneal extravasation required more aggressive transfusion with packed red cells and had a higher mortality rate in the first 24 hours.