Abdominal Trauma

Fanny Indarto
 Types
Blunt trauma
Penetrans trauma : stab wound, gun shot
wound
 General principles
The physician evaluating the abdomen should answer two
questions: (a) Is there an intra-abdominal injury and (b)
does this injury require operative repair?
While addressing these issues, two principles should not be
violated: (a) the ABCs should be adequately assessed
before focusing on the abdomen and (b) clinical
examination should be the most important element of the
evaluation.
Clinical examination can determine the need for emergent
exploration following abdominal trauma by the presence of
one or both of two signs: (a) peritonitis and (b)
hemodynamic instability. In the absence of these two signs,
there is time for more detailed investigations.

Trauma Manual, 2008

 Hemodynamic instability
Hypotension may occur in the presence of
spinal cord injury without blood loss.
Hypertension may occur even in the presence
of blood loss due to increased intracranial
pressure and a Cushing's reflex.
 Peritonitis
A significant part of the trauma population is
simply nonevaluable because of associated head
injuries, spinal cord injuries, or intoxication. Such
patients receive the most benefit from additional
studies. Intoxication, unless profound, should not
be a reason to avoid clinical examination. Most
patients with mild or moderate intoxication will
manifest abdominal tenderness on careful
evaluation, if intra-abdominal structures are
injured and the reliability of clinical examination
is not impaired.8,9
 FAST : Focus of Abdominal Sonography for
Trauma
Diagnostic Peritoneal Lavage
Abdominal CT
Diagnostic laparoscopy : left
thoracoabdominal injury
Diagnostic Peritoneal Aspiration
Current Therapy of Trauma, 2008
 Blunt trauma
If hemodynamic instability is caused by pelvic
retroperitoneal bleeding, long-bone fractures, blunt
myocardial contusion, spinal cord injury, or intrathoracic
trauma, an unnecessary laparotomy may be profoundly
detrimental.
Along the same lines, unevaluable blunt trauma patients
need further diagnostic work-up before a decision for
laparotomy is made.
The presence of a sealbelt mark sign is associated with
an incidence of about 20% of intraabdominal injuries.
These patients should be evaluated very carefully and the
threshold for laparotomy should be low
 Management
Spleen : splenectomy/splenoraphy
Liver : suturing
Bowel : resect and anastomotic, stoma
Damage control surgery