Background: Determination of intra-abdominal injury following blunt abdominal trauma (BAT) continues to be a diagnostic challenge. Ultrasound (US) bas been described as a potentially useful diagnostic tool in this setting and is being used with increasing frequency in trauma centers. We determined the diagnostic capability of US in the evaluation of BAT. Methods: A retrospective analysis of our trauma US database was performed over a 30-month period. Computed tomographic scan, diagnostic peritoneal lavage, or exploratory laparotomy confirmed the presence of intra-abdominal injury. Results: During the study period, 8,197 patients were evaluated at the Ryder Trauma Center. Of this group, 2,576 (31%) had US in the evaluation of BAT. Three hundred eleven (12%) US exams were considered positive. Forty-three patients (1.7%) had a false-negative US; of this group, 10 (33%) required exploratory laparotomy. US had a sensitivity of 86%, a specificity of 98%, and an accuracy of 97% for detection of intra-abdominal injuries. Positive predictive value was 87% and negative predictive value was 98%. Conclusion: Emergency US is highly reliable and may replace computed tomographic scan and diagnostic peritoneal lavage as the initial diagnostic modality in the evaluation of most patients with BAT.

A hollow viscus injury is an uncommon but potentially dangerous intra-abdominal injury that can result from blunt abdominal trauma. It can be misdiagnosed in patient, particularly when the patient has other concerning findings. Also, diagnosis can be increasingly difficult in a patient with a pre-existing ventral hernia and chronic abdominal pain. In this case we present a 66-year-old women, with a history of a large ventral hernia and chronic abdominal pain, who presented to the emergency department after a motor vehicle crash (MVC). Patient denied abdominal tenderness at the time of presentation and the initial computed tomography (CT) did not demonstrate any abnormal findings within the abdomen. Patient later began experiencing increased abdominal pain and presented with a small bowel perforation within the hernia that required a bowel resection and hernia repair. A review of the literature reveals that not only are hollow viscus injuries rare but there appears to be few documented cases of viscus injuries occurring within a existing ventral hernia.