Imaging of Penetrating Abdominal and Pelvic Trauma

Penetrating abdominal trauma occurs primarily from ballistics and stab wounds. Violation of the peritoneal cavity may cause a substantial number of injuries, often centered along the trajectory of the penetrating agent. Basic ballistic kinematics may be helpful to radiologists in understanding the mechanism of penetrating trauma and are briefly reviewed. CT performed on hemodynamically stable patients without peritonitis is a current near-universal standard, although there are some controversies on preferred CT protocols. Using standard portal venous phase CT imaging, an approach to solid organ, bowel, and vascular trauma is emphasized. Solid organ injuries are rarely isolated, and additional injuries to adjacent structures occur often in a path following the projectile. The direct as well as indirect signs of bowel, mesenteric, and vascular injuries are reviewed. The role of delayed imaging, rectal contrast, CT cystography, and other problem-solving imaging acquisitions performed according to present or suspected injuries is also highlighted. The purpose of this chapter is therefore to review and summarize the imaging of penetrating abdominal trauma.