MEDizzy - An intoxicated 22-year-old man is a restrained driver in a

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Trauma II

An intoxicated 22-year-old man is a restrained driver in a high-speed motor vehicle collision. Examination reveals normal vital signs, but the rest of the examination is unreliable secondary to the patient’s intoxicated state from alcohol. Which of the following sole findings on a CT scan of the abdomen and pelvis mandates an exploratory laparotomy?

ExplanationA. Free fluid in the abdomen or pelvis in the absence of solid-organ injury warrants an exploratory laparotomy to evaluate for small-bowel or mesenteric injury. DPL to evaluate the fluid for WBCs, amylase levels, or bacteria on Gram stain could be performed alternatively. However, DPL is being used less frequently because of its invasiveness. Furthermore, the lavage WBC count was found to be nonspecific for hollow viscus injuries. Findings seen on CT scan suggestive of small-bowel injury include bowel wall thickening, pneumoperitoneum, mesenteric fat streaking, and extravasation of either luminal or vascular contrast. Exploratory laparotomy is not indicated in solid-organ injury (liver, spleen, kidney) in patients with hemodynamic stability and no evidence of contrast extravasation. A pelvic fracture requires internal or external fixation if it is unstable.