Evaluation of gastrointestinal injury in blunt abdominal trauma "FAST is not reliable": the role of repeated ultrasonography

In this retrospective study we collected the data of all patients from September 2007 to July 2011 with gastrointestinal injury. The intraoperative outcome was compared with FAST technique and the repeated or delayed sonography.A total number of 1550 patients with blunt abdominal trauma underwent FAST in a period of 4 years in our hospital. Eighty-eight (5.67%) patients were found to have gastrointestinal injury after exploratory laparotomy. Fifty-five (62.5%) patients had isolated gastrointestinal injury and 33 (37.5%) patients had concomitant injury to the other solid organs. In those with isolated gastrointestinal injury, the sensitivity of FAST was 38.5%. Repeated ultrsonography was performed in 34 patients with false negative initial FAST after 12-24 hours. The sensitivity of repeated ultrasonography in negative initial FAST patients in detection of gastrointestinal injury was 85.2% (95% CI, 68.1%, and 94.4%).Repeated sonography after 12 to 24 hours in patients with negative initial FAST but sustain abdominal symptom can facilitated a diagnosis of GI tract injury and can be as effective method instead of Computed tomography in developing country.Trauma is the most common cause of mortality in 1-45 year's age group [1]. Currently ultrasonography (US) is the primary method of screening patients with blunt abdominal trauma (BAT) worldwide [1-3]. Focused Assessment Sonography for Trauma (FAST) has been previously described for the evaluation of blunt abdominal trauma to observe the presence of free fluid in the abdomen or pelvis [4].Although in some of the previous published literature they believe that it is rare to see false-negative results when screening with US (1%) [5,6]. It seems that screening BAT with FAST will lead to under diagnosis in some abdominal injuries such as; retroperitoneal (pancreatic and adrenal), vascular injuries and diaphragmatic rupture that may have a negative impact on the patients outcome [7].Due to subtle findings FAST has been report