[Diagnostic strategy in abdominal injuries].
There is persistent controversy concerning the management of patients with abdominal trauma. The major point is to determine whether or not the abdominal trauma is penetrating. In rare cases (shock, abdominal gunshot wound, peritonitis, evisceration, digestive tract bleeding and abdominal stab out of place) urgent laparotomy remains mandatory. In the other cases, although some centers recommend serial abdominal exams for asymptomatic patients, with the risk of delayed laparotomy, most authors prefer a more aggressive approach. In the case of anterior penetrating abdominal trauma, diagnostic peritoneal lavage, which is an over sensitive method, could be replaced by laparoscopy, which allows both diagnosis and treatment. Triple-contrast CT scan is the first-line diagnostic modality in penetrating back and flank trauma.