Free abdominal fluid without obvious solid organ injury upon CT imaging: an actual problem or simply over-diagnosing?

A search of the literature has made it apparent that there is no straightforward answer to the question what to do with patients with free intraabdominal fluid on CT scanning but without signs of solid organ injury. In hemodynamically unstable patients, free intraabdominal fluid in the absence of solid organ injury usually mandates immediate surgical intervention. For patients with blunt abdominal trauma and more than just a trace of free intraabdominal fluid or for patients with signs of peritonitis, the threshold for a surgical exploration - preferably by a laparoscopic approach - should be low. Based on the available information, we aim to provide the reader with an overview of the current literature with specific emphasis on diagnostic and therapeutic approaches to this problem and suggest a possible algorithm, which might help with the adequate treatment of such patients.The introduction of routine computed tomography (CT) in trauma exposes us to a plethora of new information, sometimes leaving us with more information than we had bargained for. Although a recent study by Huber-Wagner and colleagues was able to show a positive effect on overall survival of trauma patients with blunt injury receiving whole-body CT during emergency department resuscitation [1], the study does not specifically evaluate abdominal trauma and free intraabdominal fluid without solid organ injury. The question as to what to do with this subgroup of patients remains a matter of debate.Whilst sonography and conventional radiography remain well-established techniques, CT scanning of the abdomen and pelvis is the procedure of choice to evaluate the hemodynamically stable patient who has sustained blunt or penetrating trauma. CT has replaced Diagnostic Peritoneal Lavage (DPL) as the first method of choice in many trauma centers worldwide. Its major advantage is that it is not only capable of revealing the presence of intra-abdominal or intra-thoracic hemorrhage but can to some extent also i