 Hello everyone, Myself Dr. Rahul, I am a third year junior resident in JGM Medical College, Dhawan Gere. I will be presenting paper on role of MDCT as an initial modulator for evaluation of blunt injury abdomen. Coming to the introduction part. As we know trauma is one of the leading cause of death overall for all the ages. Road traffic, crashes kills around 1.2 million people annually around the world. 90% of these deaths are in low or middle income countries and Indian fatality rates are about 20 times more than the other developed countries. And 10% of these fatalities are related to the abdominal injury. About 30% of such deaths are preventable with proper diagnosis and proper treatment. Materials and methods. We included 50 patients with a blunt injury abdomen were evaluated in a period of 12 months. The various organs injuries were graded and the scoring system applied for the hemoperitoneum. The patients were managed according to the CT findings. The techniques used are like the scanner was GE Revolution Act 32 slice. The standard KVP like 120 and MES 165 the detector collimation was 2 mm. The slice thickness was kept around 2.5 to 5 mm. The IV contrast value was around 1.22 cc per kg. The concentration was around 300 mg per ml. The objective of the study is to study the role of computer tomography in the evolution of intraabdominal injury in a patient with a blunt injury abdomen and accurate grading of those injuries and to provide the information that could determine the appropriate choice of management. Inclusion criteria all trauma cases with a suspected intraabdominal injury. The most common findings in any abdominal trauma is hemoperitoneum and the organ injury. So hemoperitoneum is estimated using the federal et al. studies model. So whenever there is a fluid in only one space it is taken as a small estimated small hemoperitoneum. Approximate amount will be 100 to 200 ml. And any fluid in a two or more spaces it will be estimated as a moderate and approximate amount will be 250 to 500 ml. Or fluid in all spaces or pelvic fluid or anterior superior to the urinary bladder will be estimated as a large hemoperitoneum more than 500 ml. As you can see here there is a fluid around the perihepatic and perisplanic. So more than two spaces it will be considered as a moderate. And third, fourth, fifth diagram, second diagram you can see there is a fluid in a pelvic cavity and scrotum in multiple spaces. It will be considered as a severe hemoperitoneum more than 500 ml. And the grading system organ injury used a standard grading system. So whenever there is a laceration less than one centimeter or subcapsular hematoma less than one centimeter it will be taken as a grade one. Or laceration one to three centimeter or subcapsular hematoma less than three centimeter will be taken as a grade two. The laceration more than three centimeter deep or central or subcapsular hematoma more than three centimeter in taken as a grade three. And laceration more than ten centimeter subcapsular hematoma more than ten centimeter. Lower maceration, divascularization, extending into the any happy major hepatic vein taken as a grade four. Grade five will be taken as whenever there is a bilubar tissue maceration, parenchymal contrast blush, arterial contrast extortion beyond capsules taken as a grade five. So you can see there is a small hypodensity in the first image and it is will be taken as a grade one injury. And second image you can see there is a hypodensity area more than three centimeter in perihepatic fluid collection. It will be taken as a grade three liver injury. And you can see here this large hematoma more than ten centimeter it will be taken as a grade four hepatic injury. So coming to this planic injury grading it is as same as a liver less than one will be taken as a one grade one. One to three centimeter will be taken as a grade two. Laceration more than three centimeter and subcapsular hematoma more than three it will be taken as a grade three. Parenchymal fragmentation to two or more section will be taken as a grade four. Interparenchymal contrast blush or extortion beyond the capsule will be taken as a grade five. So you can see there is a first diagram there is a small linear hypodensity will be taken as a grade one. And second image you can see there is a hypodensity more than three centimeter it will be taken as a grade three. Coming to the pancreatic injury if there is a minor contusion it will be taken as a grade one. If it's a major contusion it will be taken as a grade two. If distal transaction or parenchymal injury with a duct injury it will be taken as a grade three. If there is a proximal transaction or to the right of the eccentric vein or a parenchymal injury involving the ampulla it will be taken as a grade four. If it's a massive disruption of pancreatic head it will be taken as a grade five. And here you can see there is a hypodensity area in the body and the head of the pancreas it will be considered as a grade five pancreatic injury. Coming to the renal injury the contusion small contusion and non-expandance of capsular hematoma without any laceration is taken as a grade one. Our non-expanding minimal parenchymal hematoma or cortical laceration less than one centimeter without any renal extortion will be taken as a grade two. The laceration more than one centimeter without any renal extortion but the larger parenchymal hematoma it will be taken as a grade three. Laceration through the corticometallary junction and to collecting system or segmental renal artery or vein content hemorrhage it will be taken as a grade four. Or shattered kidney evolution of renal pedicle is taken as a grade five. And you can see here a small hypodensity area without any parenchymal hematoma it will be taken as a grade one. And here you can see there is a hypodensity area transferring through the corticometallary junction. So it will be taken as a grade three renal injury with a large parenchymal hematoma also seen here. And here you can see there is a large hematoma which is around the parenchymal hematoma and there is a transaction of the whole corticometallary section. So it will be taken as a grade four. And whenever there is a contrast extortion outside the bladder it will be taken as a bladder considered as a bladder rupture. So in coming to the observation and results we had 50 cases. In 50 cases around 42 cases were positive, 8 cases were negative. So whenever there is a hemoperitoneum and organ injury it is considered as a positive. No organ injury, no hemoperitoneum considered as a negative. So around positive cases 42 hemoperitoneum was seen in around 32. Only isolated hemoperitoneum seen in 12 cases associated with the other organ injury hemoperitoneum seen in 20 cases. And the solid organ injury was seen in 30 cases. Solid areas organ injury seen in 22 cases. Multiple organ injuries seen in around 8 cases. The quantification of hemoperitoneum as a small moderate and large. There are around 16 cases were seen small hemoperitoneum. Around 90% of them are conserved managed conservatively. And moderate and large they can managed around 60 to 70% of cases are managed conservatively. And around 10 to 20% of cases are managed operatively. The distribution of visual organs. The sprain is the most common organ followed by liver. The least organ injury seen in the pancreas. This is the grading system of the individual organs. Coming to the most common grading was seen in around grade 1. It is seen in around 8 cases. Grade 2 injuries seen around 5 cases. The least grading was seen in around grade 4 cases. And grade 1 to 3 cases are almost all managed conservatively. Grade 4 and 5 managed operatively. In our among total 30 cases around 80% of cases are managed conservatively. Around 20% of cases managed operatively. So overall management we had a negative cases. 8 negative cases they are managed conservatively. Hemoperitoneum seen in around 12 cases. Isolated hemoperitoneum seen in around 12 cases. Among them 9 managed conservatively. 3 managed operatively. And solid organs are seen in around 30 cases. 23 cases were managed conservatively. 7 cases managed operatively. So total 40 cases of 80% of managed conservatively. Around 10 cases managed operatively. To the 20% of the whole cases. So conclusion is the multilateral CT is a very sensitive and specific method for the assessment of various organ injury and hemoperitoneum in patients with blunt abdomen trauma. Contracellum CT and particular multilateral CT is a fast, accurate and relatively safe. And can be done in a patient who are immunodynamically unstable. The most useful information is obtained during a portal phase of the scanning. Accurate grading of solid organ injuries, accurate scoring of hemoperitoneum, helipsin planning and appropriate line of management. That is either operative or non operative or conservative management. These are my references. Thank you.