27 - IDENTIFYING RADIOGRAPHIC AND CLINICAL INDICATORS TO REDUCE THE OCCURRENCE OF NON-THERAPEUTIC LAPAROTOMY FOR BLUNT BOWEL AND MESENTERIC INJURY

Objectives: Roughly 5% of patients presenting to the emergency department with blunt abdominal trauma have suffered a blunt bowel and/or mesenteric injury (BBMI). Determining the need for operative versus nonoperative management in this patient population can be quite challenging in the presence of hemodynamic stability. This is especially true given the absence of a current, universally accepted practice management guideline in the trauma surgery literature. Few single center studies have proposed scoring systems based on CT findings to guide clinical decision-making. Our study aimed to determine the predictability of findings on abdominopelvic CT scan (CT A/P) in conjunction with initial clinical exam findings to determine the necessity of operative intervention for BBMI in patients with blunt abdominal trauma.

Methods: Patients presenting from 2017-2022 to our Level 1 trauma center after motor vehicle collision with subsequent CT A/P were retrospectively reviewed using our trauma center registry database. The charts of patients with CT findings suggestive of blunt mesenteric injury were then further analyzed, specifically noting CT findings, admission Glasgow coma scale (GCS), initial shock index, initial abdominal exam, hospital course, presence or absence of surgical management, and when applicable, intra-operative intervention performed.

Results: 1098 patients that presented to our facility for blunt abdominal trauma after motor vehicle collision initially underwent an abdominopelvic CT scan. 139 (12.7%) patients had at least one CT finding suggestive of BBMI. Of those patients, 38 (27%) underwent surgical exploration, and 30 (22%) had a surgically-confirmed BBMI. Only 27 (71%) of the patients who underwent surgical exploration required bowel or mesenteric intervention. Univariate analysis indicated four individual CT findings and one clinical finding that were significantly associated with bowel or mesenteric intervention: pneumoperitoneum (p < 0.0001), active extravasation of contrast (p = 0.0001), hemoperitoneum without concomitant solid-organ injury (SOI) (p < 0.0001), peritonitis (p < 0.0001), and mesenteric stranding (p < 0.05).

Conclusion: Of 1098 patients meeting study criteria, 30 (2.7%) had a surgically confirmed BBMI. The individual presence of active bleeding, pneumoperitoneum, hemoperitoneum without SOI, mesenteric stranding, and/or peritonitis proved to be significant indications for need for bowel or mesenteric intervention. Without the presence of these findings, a combination of CT and clinical findings cannot reliably predict the need for surgical intervention. To minimize the occurrence of negative laparotomy, strong consideration should be given to initial nonoperative management with serial clinical exams to reduce the rate of nontherapeutic laparotomy in hemodynamically stable patients without these findings.