Blunt trauma and acute diseases of the abdomen and chest: Free fluid – what now?

Next to clinical evaluation, free fluid is a critical determinant of treatment urgency in the case of a consequence of trauma or an acute disease of the abdomen and chest.

Surgeons must perform exploratory laparotomy/scoping for every acute abdomen and every trauma with free fluid unless it can be proven that the disease/consequence of an injury can be treated conservatively. In addition to symptoms, the amount of free fluid detected on ultrasound can serve as an indication for exploratory laparotomy in cases of doubt. In the case of every relevant intraabdominal and, to a lesser extent, intrathoracic disease requiring immediate treatment, free fluid can be detected on ultrasound with very high sensitivity and specificity. The reverse conclusion can also be made: no free fluid, no disease requiring immediate treatment. In contrast, direct detection of the underlying disease on ultrasound and radiology has significantly lower rates of sensitivity.

• References

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