The usefulness of the ultrasonography (US) for the indication for
laparotomy was evaluated. I analyzed 200 blunt
trauma patients who took US exams at my emergency center immediately after admission. Ninety-five percent of patients with hemodynamic instability, whose
hemoperitoneum was revealed by US, underwent
laparotomy. No negative
laparotomy was performed in those patients. Only 5.4% of US
hemoperitoneum-negative patients with stable hemodynamics required
laparotomy because of peritoneal irritation or the evidence of
traumatic diaphragmatic hernia. US
hemoperitoneum-positive patients with stable hemodynamics were treated selectively, and 46% of such patients eventually underwent
laparotomy, depending on findings of serial US, CT, DPL and Intravenous urogram. In two third of them
laparotomy was indicated because of serial US showing the appearance or increase in
hemoperitoneum. The maximum width of echo free space in Morison'
s pouch became more than 10 mm in the all exams when the
laparotomy was indicated. I believe that US finding of
hemoperitoneum should be an integral part of evaluating
laparotomy indications in blunt abdominal
trauma.