To investigate the diagnostic value of spiral CT in difficult abdominal injuries. Methods Prospectively analyzed 87 patients with difficult abdominal injuries admitted to the emergency department from August 2003 to November 2005, divided into 41 cases in the conventional group and 46 cases in the CT group, and compared the rate of non-therapeutic dissection, the average preoperative operation time, and postoperative complications between the two groups. Results There were 15 cases of non-therapeutic dissection in the conventional group, with an average preoperative operating time of 25 hours, 7 cases of postoperative intestinal fistula, and 5 cases of death; there were 2 cases of non-therapeutic dissection in the CT group, with an average operating time of 11 hours, 2 cases of postoperative intestinal fistula, and 1 case of death. Conclusion Spiral CT is an effective diagnostic tool for difficult abdominal injuries. Inclusion criteria for patients with difficult abdominal injuries: (1) there are combined injuries of cranial, pelvic, lumbar spine, and thorax that mask abdominal injuries; (2) abdominal injuries may be combined with distal small bowel and colon perforation, late appearance of peritonitis, and slow progression; (3) the diagnosis cannot be clearly made by history, symptoms, signs, ultrasound, and diagnostic laparotomy; (4) hemodynamically stable and able to accept spiral CT. The conventional group used history, symptoms, signs, ultrasound and diagnostic laparotomy to formulate the diagnosis and treatment plan; the CT group combined history, symptoms, signs, ultrasound, diagnostic laparotomy and spiral CT examination to formulate the diagnosis and treatment plan. The results were analyzed by applying statistical methods. For abdominal injuries, general cases can be diagnosed and treated early with good prognosis by taking medical history, physical examination, abdominal ultrasound, and diagnostic puncture. However, for cases of difficult abdominal injuries, the diagnosis is often not clear and misdiagnosed through the above-mentioned means, resulting in adverse consequences. There is no unified standard for the diagnosis of difficult abdominal injury, and the authors’ experience suggests that those with the following conditions can be diagnosed as difficult abdominal injury. Patients with comorbidities that mask abdominal symptoms, combined with orthopedic diseases, such as pelvic and lumbar fractures on the one hand, there are more posterior peritoneal hematoma can cause abdominal distension, abdominal pain, on the other hand, can cause intestinal paralysis, secondary to intestinal dilation, pneumatization, fluid accumulation and increase abdominal distension, abdominal pain; combined with brain surgery diseases such as coma, the patient does not answer; combined with the chest and other life-threatening injuries and may ignore the abdominal injury; abdominal injury combined with intestinal perforation is located in The perforation is small, early due to intestinal spasm, intestinal mucosa ectasia, intestinal thick contents blocking the perforation, large omentum wrapping perforated intestinal segment, early no or peritonitis signs are not obvious, and peritonitis signs progress slowly, ultrasound, diagnostic laparotomy is mostly false negative results. Diagnostic laparotomy in patients with suspected abdominal injury is often caused by false positive results due to inadvertent retroperitoneal hematoma and dilated intestinal canal, or false negative results due to peritoneal fluid encapsulation. ultrasound causes false negative results due to pneumoperitoneum and thick fluid. Spiral CT is not affected by pneumoperitoneum, dilated intestine, thickened or encapsulated fluid, and can clearly show liver, spleen, kidney and retroperitoneum to help diagnosis and treatment. For general abdominal injuries, the accuracy of diagnosis of liver, spleen, kidney and other intra-abdominal organ injuries is 92% based on clinical signs and abdominal puncture, etc. The sensitivity of CT examination [2] is 96.5%, the specificity is 90%, and the accuracy is 96%, and for difficult abdominal injuries, combining CT examination is more beneficial for diagnosis and treatment. The results of our study showed that the cases of non-therapeutic dissection in the spiral CT group were significantly lower than those in the conventional group, with a statistical difference (P = 0.002), which is due to the fact that non-therapeutic dissection mainly occurs in cases with combined retroperitoneum, diagnostic laparotomy often mistakenly enters the retroperitoneal hematoma and obtains false positive results, and B ultrasound affects the examination results due to dilatation of the intestine and pneumatization, while spiral CT can accurately reflect without interference Spiral CT can accurately reflect intra-abdominal injuries without interference and reduce non-therapeutic dissection. For patients who can undergo CT, CT is the best means to diagnose retroperitoneal hematoma [3]. Also for simple splenic rupture, the authors have studied a group of cases with spiral CT examination, 3 cases were successfully treated conservatively, 7 cases were cured by splenectomy with an average transfusion of 1200 ml; in the conventional group, 2 cases were successfully treated conservatively, 2 cases were cured by non-therapeutic dissection (small fissures in the splenic peritoneum, which had stopped bleeding on their own after dissection), 6 cases were cured by splenectomy with an average transfusion of 1800 ml, with significant differences. There were statistically significant differences in operative time (P = 0.001), postoperative intestinal fistula (P = 0.026), and postoperative death (P = 0.05) in this data CT group compared with the conventional group. In the conventional group, there were five fatal cases, one died of craniocerebral trauma, and the remaining four cases had an operative time of more than 96 hours, postoperative intestinal fistula, abdominal infection, toxic shock, and finally death; seven cases of intestinal fistula, five had distal small bowel perforation, one had cecum perforation, and one had descending colon perforation, all with an operative time of more than 60 hours. one case in the CT group had multiple perforations of the transverse colon and descending colon, with an operative time of 18 hours. two cases in the CT group Two cases in the CT group were considered intestinal rupture and non-therapeutic abdominal dissection was performed. Difficult abdominal injury intestinal perforation is often located in the terminal small intestine, cecum and rectum, the perforation is small, early due to intestinal spasm, intestinal mucosa ectasia, intestinal thick contents blocking the perforation, large omentum wrapping perforated intestinal segment, early no or peritonitis signs are also not obvious, and peritonitis signs progress slowly, ultrasound, diagnostic laparotomy is mostly false negative results, delayed diagnosis leads to prolonged operation time and postoperative complications. Combined with spiral CT examination, it can significantly early diagnosis, shorten the operation time and reduce postoperative complications.