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Abdominal Trauma
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Objectives
 Describe external and internal anatomy
 Recognize blunt vs penetrating injury

Patterns
 Indentify signs different types of injuries

 Apply diagnostic and therapeutic

Procedures
 Demonstrate and discuss DPL
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Abdominal Trauma
 Unrecognized injury : Cause of
preventable death
 Exam compromised by
• Alcohol, illicit drugs
• Injury to brain, spinal cord
• Injury to ribs, spine, pelvis
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Anatomy
External
 Anterior abdomen

 Flank

 Back
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Anatomy
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Mechanism of injury
Blunt
 Spleen, liver, and Hollow viscus

 Compression

 Crushing

 Shearing

 Deceleration (fixed organs)

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Mechanism of injury
Penetrating
 Liver , small bowel, and colon

 Laceration / low energy

 Kinetic energy / high energy

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Assessment : History
Blunt Penetrating
 Speed  Weapon

 Point of impact  Distance

 Intrusion

 Safety devices

 Position

 Ejection
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Assessment : Physical Exam

 Inspection
 Percussion
 Palpation
 Auscultation
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Assessment : Physical Exam

 Local wound exploration by surgeon
 Pain over bony pelvis
 Genitourinary, perineal, rectal,vaginal
and gluteal
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Adjuncts : Intubation
Gastric Tube
 Relieves dilatation

 Decompresses stomach before DPL

• Basilar skull/facial fractures

• induce vomiting/ aspiration
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Adjuncts : Intubation
Urinary Catheter
 Monitors urinary output

 Decompresses bladder before DPL

 Diagnostic

Urethral injury
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Adjuncts : x – ray Studies

Routine
 Blunt : AP chest, pelvis

 Penetrating : AP chest, abdomen with

markers (if hemodynamically normal)

Contrast
 Urethrogram
 GI
 Cystogram
 IVP
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Special Studies in Blunt Trauma

DPL US* CT
Time Rapid Rapid Delayed
Transport No No Required
Sensitivity High High? High
Specificity Low Intermediate High
Eligibility All All patients Hemodyna
patients mically normal
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Indications for Celiotomy

Blunt Penetrating
 + DPL or  + DPL or ultrasound

ultrasound  Peritoneal/

 ↓BP suspected retroperitoneal injury

visceral injury  Peritonitis
 Peritonitis
 Hypotension

 Evisceration
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Indications for Celiotomy

Plain X – ray
• Free air
• Retroperitoneal air
• Ruptured diaphragm
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Indications for Celiotomy

Special Studies
• CT scan : Free air, visceral injury ? Fluid?
• Cystogram : Bladder rupture, intraperitoneal
injury
• Arteriogram: Renal pedicle occlusion
• Upper GI : Duodenal rupture
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Special Problems : Blunt Trauma

Diaphragm : Abnormal chest x –ray
Duodenum/ Retroperitoneal air, contrast
small bowel : seat belt sign, chance
fracture ,free air
Pancreas : Amylase ?, CT ?
GU : Extravasation of contras
nonfunctioning renal
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Pelvic Fractures
 Significant force
applied
 Associated injuries
 Pelvic bleeding
• Ends of bones
• Pelvic muscles
• Veins/arteries
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Pelvic Fractures
Mechanism Classification
 AP  Open

(anteroposterior)  Closed
compression
 Lateral

compression
 Vertical shear
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Pelvic Fractures
Assessment
 Inspection

 Palpate prostate

 Pelvic ring

• Leg-length disrepancy , external rotation

• Pain on palpation of bony pelvic ring
• AP x - ray
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Pelvic Fractures : Management

Resuscitate

Transfer as needed with PASG

Determine if intraperitoneal hermorrhage

Operation
Control hemorrhage Fixation device

Possible angiography
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Questions
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Summary
 ABCDEs
 Delineate mechanism
 Repeated exams
 Diagnostics as needed
 High index of suspicion
 Early recognition /prompt celiotomy