Abdominal Trauma
Begashaw M (MD)
Anatomy
Abdominal Trauma
 Two
mechanisms
_Bluntusually causes solid organ injury
(spleen injury is most common)
_Penetratingusually causes hollow organ
injury or liver injury (most common)
Mechanism of Injury

Blunt Force Trauma

Penetrating Trauma
Mechanism of Injury Africa style
Mechanism of Injury

Blunt
– Speed
– Nature of Impact
– Position in vehicle
– Ejection
– Intrusion
– Seatbelt
– Airbag

Penetrating
– Type of weapon
– Distance
– Number and
location of wounds
– Trajectory
– Energy
– Blast effect
BLUNT TRAUMA

results in two types of hemorrhage
- intra-abdominal bleeding
- retroperitoneal bleeding
 adopt high clinical suspicion of bleeding in
multi-system trauma
Examination

Abdomen
Inspect: contusions, abrasions, seatbelt sign,
distention
Auscultate: bruits,bowel sounds
Palpate: tenderness, rebound tenderness,
rigidity, guarding
DRE: rectal tone, blood, bone fragments,prostate
location
Placement - NG, foley catheter
Commonly injured organs

Spleen
 Liver
 Small Bowel
Assessment of abdominal trauma

Difficult due to:
_Altered sensorium (head injury, alcohol)
_Altered sensation (spinal cord injury)
_Injury to adjacent structures (pelvis, chest)
Investigations

Labs: CBC, electrolytes,cross & type,
glucose, creatinine, amylase, liver enzymes
 Imaging
Imaging
Imaging
strengths
limitations
X-ray
Erect CXR
Soft tissue not
visualized
CT scan
Most specific test
Radiation,cannot use
if hemodynamic
instability
Diagnostic
peritoneal Lavage
Most sensitive test
Test for intra
abdominal bleeding
Retroperitoneal
hemorrhage,
diaphragmatic
rupture
Ultrasound FAST
Free fluid, Rapid,
pericardium, plura
Specific organ
injury
FAST

Focused assessment for the sonographic assessment
of trauma
 Assess for intraperitoneal fluid
o Right upper quadrant
o Left upper quadrant
o Suprapubic region
 Fluid in subphrenic, subhepatic spaces or Pouch of
Douglas in hypotensive patient
 Confirms likely need for emergency laparotomy
FAST
Criteria for positive DPL

>10 cc gross blood
 Bile, bacteria. foreign material
 RBC count >I 00,000
 WBC >500
 Amylase > 1751U
Imaging

Equivocal abdominal examination,
suspected intra-abdominal injury
 Multiple trauma
 Unexplained shock/hypotension
 Fractures of lower ribs, pelvis, spine
 positive FAST
Management






General: ABCs, fluid resuscitation and stabilization
Surgical: watchful wait vs laparotomy
Solid organ injuries: decision based on
hemodynamic stability, not the specific injuries
Hemodynamically unstable or persistently high
transfusion requirements: laparotomy
Hollow organ injuries: laparotomy
Even if low suspicion on injury: admit and observe
for 24 hours
Indications for Laparotomy

Free Fluid on FAST
 Unstable patient with suspected abdominal
injury
 Free Air
 Diaphragm Rupture
 Peritonitis
 Positive findings on CT Scan
PENETRATING TRAUMA



High risk of gastrointestinal perforation and sepsis
History: size of blade, calibre/distance from gun,
route of entry
Local wound exploration under direct vision may
determine lack of peritoneal penetration (not reliable
in inexperienced hands) with the following
exceptions:
-thoracoabdominal region (may cause
pneumothorax)
-back or flanks (muscles too thick)
Penetrating Trauma

Overall condition of
the patient
 Local wound
exploration
 DPL?
Penetrating abdominal trauma
Laparomy in penetrating
injury

Shock
 Peitonitis
 Eviseration
 Free air in abdomen
 Blood in NG tube, Foley catheter, or on
rectal exam
Management
 General: ABCs,
fluid resuscitation and
stabilization
 Gunshot wounds-always require laparotomy