gunshot wound to the flank and back

Q: Patients with a gunshot wound (GSW) to the flank and back should get?

A) Diagnostic peritoneal lavage (DPL)
B) Bedside ultrasound (US)
C) Diagnostic laparoscopy
D) CT scan of the abdomen and Pelvis with IV, oral, and rectal contrast
E) CT scan of the abdomen and Pelvis, only with oral contrast, saving the kidney


Answer: D

Patients with a gunshot wound (GSW) to the flank and back should be evaluated with a different approach. Due to the location of the injury DPL, the US or diagnostic laparoscopy may not provide adequate or may even mislead the extent of the injury. The best tool would be a CT scan of the abdomen and the pelvis with IV, oral, and rectal contrast. This will reliably delineate the path of the missile and extent of the injury. 

As far as a patient is having good urine output and Creatinine is normal, IV contrast can be given safely (choice E)

#trauma


References: 

1. Albrecht RM, Vigil A, Schermer CR, et al. Stab wounds to the back/flank in hemodynamically stable patients: evaluation using triple-contrast computed tomography. Am Surg 1999; 65:683.

2. Ginzburg E, Carrillo EH, Kopelman T, et al. The role of computed tomography in selective management of gunshot wounds to the abdomen and flank. J Trauma 1998; 45:1005.