In the context of suspected intra-abdominal injury after resuscitation, which imaging modality is considered the standard initial cross-sectional assessment for a hemodynamically stable patient?

• A. Diagnostic peritoneal lavage
• B. Ultrasound FAST
• C. Abdominal X-ray
• D. CT scan of the abdomen and pelvis

Answer: (D)

In a hemodynamically stable patient with suspected intra-abdominal injury after resuscitation, a CT scan of the abdomen and pelvis with IV contrast is the preferred initial cross-sectional imaging. This modality provides a comprehensive and highly sensitive view of the abdominal organs, including solid organ injuries (liver, spleen, pancreas, kidneys), mesenteric and vascular injuries, and retroperitoneal structures, as well as the presence of any free fluid or air. The information from a CT helps determine whether nonoperative management is appropriate or if operative intervention is needed, and it guides the necessary treatment plan with greater accuracy than other options.

Ultrasound, such as FAST, is useful at the bedside to quickly identify free intraperitoneal fluid, especially in unstable patients or when rapid assessment is needed, but it does not offer the detailed cross-sectional view and can miss retroperitoneal or certain subtle injuries. Diagnostic peritoneal lavage is invasive and largely outdated in stable patients, while abdominal X-ray has limited utility for detecting intra-abdominal injuries and often misses those that CT can reveal.