Abdominal computed tomography prior to trauma laparotomy: a roadmap or detour? A pro-con debate

The use of abdominal computed tomography (CT) for trauma has grown tremendously in the past several decades, to the point that it is now a regular part of the trauma work-up. Increased utilization of CT has reduced non-therapeutic laparotomy for trauma, which is associated with significant morbidity. Traditionally, findings on physical examination including hemodynamic instability, evisceration, and peritonitis were indicators to proceed with laparotomy without preoperative imaging. However, growing use of and comfort with CT imaging has led to a shift in practice during which patients who meet the traditional indications for emergent laparotomy are proceeding to CT pre-operatively. The use of pre-operative CT for patients meeting criteria for emergency laparotomy was debated at the 42nd Annual Point/CounterPoint Acute Care Surgery Conference in Baltimore, Maryland. The following article summarizes the discussion points along with an overview of supporting evidence.