Multidetector CT Findings in the Abdomen and Pelvis after Damage Control Surgery for Acute Traumatic Injuries RadioGraphics 2019; 39:1183–1202 Lauren F. Alexander, MD • Tarek N. Hanna, MD • Jordan D. LeGout, MD • Manohar S. Roda, MD • Joseph G. Cernigliaro, MD • Pardeep K. Mittal, MD • Peter A. Harri, MD Jeffrey S. Klein, MD This is Jeff Klein, Editor of Radio- Graphics and today I am pleased to have with us Dr. Lauren Alexander from the Department of Radiology at the Mayo Clinic in Jacksonville, Florida; and Dr. Tarek Hanna from The Department of Radiology and Imaging Sciences at the Emory University School of Medicine in Atlanta, Georgia who are the authors of one of our featured papers in the current July, 2019 issue of RadioGraphics. Their paper is entitled “Multidetector Computed Tomography Findings in the Abdomen and Pelvis after Damage Control Surgery for Acute Traumatic Injuries.” Dr. Alexander and Hanna, thank you for joining us for today’s podcast. Lauren F. Alexander, MD Thank you. Tarek Hanna, MD Thank you very much. JSK So Dr. Alexander your paper is a really important one and it’s derived from the experience with CT follow- ing damage control surgery from four different institutions. Can you give us a sense of what you found when you were looking at literature on this particular topic as it relates to imaging and why your group felt compelled to develop the exhibit from which this particular article is derived? LFA Thank you. My interest in this topic has grown from my cumulative experience as a resident and then a faculty myself at three different institutions at different level one trauma centers. All of these sites we found it really chal- lenging to interpret this particular type of a case especial- ly when we didn’t have the time or the opportunity to dis- cuss with our surgeons what the patient underwent in the OR, why they went to the OR. And so we found that even though trauma injury crosses multiple specialty areas and multiple types of surgery, there are some common themes which can arise and that we’ve reviewed in this paper. The literature for this particular role of imaging in patients af- ter emergency surgery is small, but it is increasing and at least ten to thirty percent of patients may go to surgery be- fore they get a pre-procedure study. The additional injuries that we have seen in the research that can be identified with early post-operative imaging can then affect further care so we think it’s important to image these patients seen after surgery. And what our group really hopes to find is that by focusing on these common findings and the challenges of interpreting these examinations, we can encourage future research for this particular question and also help radiolo- gists when they’re interpreting these studies feel more com- fortable with the typical findings in this population. JSK Terrific, thanks so much. So Dr. Hanna let’s move to you. Following an introduction that provides some of the perspective on the scope of this issue at least in the Unit- ed States, the paper delves into the initial assessment and management of these traumatized patients. You discuss and in Figure 1 you illustrate the so-called vicious bloody cycle which is described in the surgical literature and then you detail the use of damage control surgery or DCS for short which is serious of procedures and resuscitation steps that are employed to try to stabilize these patients. Table 1 lists the indications for damage control surgery which we can now show to our audience. Can you tell our audience what DCS actually entails? TH Sure, yeah. So as you implied, I think it’s most accu- rate to conceptualize DCS not as a single surgery, but rather as a series of steps intended to preserve a severely traumatized patient’s life. About ten percent of trauma patients are candi- dates for DCS and in these patients, patients are taken imme- diately to the operating room in order to control hemorrhage and stabilize life-threatening injuries. For bleeding this involves packing laparotomy pads, cautering pressure, even ligation or bypass for bleeding that’s not being controlled in other ways. Now in the case of peritoneal DCS, DCS can actually occur in the thorax of the retroperitoneum and other areas of the body. The bowels interrogated, devitalized bowel segments are excised, then ileostomies or colostomies are created as needed. Now biliary pancreatic and urine leaks if they’re present are di- verted or drained rather than repaired, so we minimize surgical time and then get the patient as quickly as possible to the ICU and there are three core things that happen in the ICU. You want rewarm the patient to raise core body temperature. We want to correct an acidosis which occurs in these severely trau- matized patients and lower lactate; and then we want to give the patient transfusions in order to raise hemoglobin hemato- crit and keep up perfusion. And then the surgeons, the trauma team, assembles a team of subspecialists if needed, urologists, vascular surgeons, and then takes the patient back to the oper- ating room 48 to 72 hours later to definitively surgically treat the patient. This whole series of steps I think can be brought up as DCS all with the intention of having these patients get a better chance of recovery. JSK Terrific, thanks. So Lauren, obviously the main purpose of this review is to make radiologists aware of