Isolated Free Fluid without Pneumoperitoneum on Computed Tomography in Blunt Abdominal Trauma: Laparotomy Better Based on Imaging Finding and Clinical Presentation

Background: This study examines the clinical assessment and management of patients sustaining blunt abdominal trauma (BAT) with unexplained intra-abdominal free fluid. Methods: All adult patients (age A¯Â‚³18 years) presenting with BAT to our trauma center over a 7-year period were reviewed. Those with abdominal computed tomography (CT) demonstrating intra-peritoneal free fluid but neither solid organ injury nor pneumoperitoneum were studied further. Demographic data, radiologic interpretation, operative findings, clinical management and outcome were analyzed. Results: 115 patients met the inclusion criteria. Except 9 patients for non-operative management, 91 patients (86%) underwent therapeutic laparotomy, in whom 83 patients (78%) benefited from surgical intervention and 15 patients (14%) underwent non-therapeutic laparotomy, in whom 8 patients (8/15=53%) had retroperitoneal hematoma with associated pelvic fractures. Mesenteric tear, urinary bladder rupture, and bowel injury constituted 81% (93/115) of the studied patients. Both bowel injury and mesenteric tear had a significantly higher rate of bowel wall thickening, mesenteric hematoma and streaky sign on CT scan. Urinary bladder rupture was associated with a significantly longer hospital stay, higher injury severity score (ISS), a higher rate of associated pelvic fracture (47%) and gross hematuria (97%). Conclusions: Laparotomy might be suggested for BAT patients with free fluid collection without solid organ injury and pneumoperitoneum on CT scan because most of these patients benefited from the surgical intervention (78%), especially when there are combined with clinical presentation of gross hematuria or CT images of bowel wall thickening or mesenteric lesion.