BLUNT TRAUMA ABDOMEN

(SPECIAL FOCUS ON SPLEEN & LIVER)

INTRODUCTION & ETIOLOGY

Presenter: Rajat Chaudhary

Moderator: Dr Rupesh Shah
Introduction LEARNING OBJECTIVES
Epidemiology
Types of Injury
Causes of Blunt Trauma
Mechanism of Blunt Trauma
Liver
o Anatomy and blood supply
o Pathophysiology
 Spleen
o Anatomy and blood supply
o Pathophysiology
 INTRODUCTION
• Trauma, or injury, is defined as cellular disruption caused by an
exchange with environmental energy that is beyond the body’s
resilience which is compounded by cell death due to
ischemia/reperfusion..(Schwartz)
• seventh leading cause of death( World)
• third leading cause of death.(Nepal ,contributing to 9% of total
mortality)
• Blunt injuries causes solid organs injuries more
often than hollow viscera.
• Multi organs and multisystem injury is more
common.
 EPIDEMIOLOGY
• Peak incidence : 15-40 years.
• More common in men.
• Types : Blunt: 90%
Penetrating:10%
• More than 1.5 lakh people die yearly as a result of
motor vehicle injury, falls, suicides and homicides.
• Estimates indicate that by 2020 8.4 million people
will die yearly.
TYPES OF INJURY
Blunt Trauma Penetrating Trauma

In general, more energy is transferred

over a wider area Localized area

associated with multiple widely damage is localized e.g to the

distributed injuries path of the bullet or knife

organs that cannot organs with the largest surface area

yield to impact by elastic deformation when viewed from the front are most
are most likely to be prone to injury (small
injured, namely, the solid organs bowel, liver, and colon)
(liver, spleen, and kidneys).

* Schwartz
Pattern of Injury in Blunt Abdominal Trauma

Spleen 40.6% Colorectal 3.5%

Liver 18.9% Diaphragm 3.1%

Retroperitoneum 9.3% Pancreas 1.6%

Small Bowel 7.2% Duodenum 1.4%

Kidneys 6.3% Stomach 1.3%

Bladder 5.7 Biliary Tract 1.1%

* Rosen: Emergency Medicine (1998)
SOLID ORGANS-
• Solid organs most commonly injured in blunt traumas
• In decreasing incidence of injury
• Spleen, liver, kidneys, intraperitoneal small bowel, bladder,
colon, diaphragm, pancreas and duodenum
HOLLOW VISCERA:
- duodenum commonly injured
- Small bowel injured at relatively fixed areas (duodenojejunal
flexure and ileocaecal junction) by shearing force
- Colon relatively protected.
- Gaseous distension of caecum – most vulnerable part as
fixed.
- Stomach rarely injured – compression cause esophagogastric
junction bursting
RETROPERITONEUM AND UROGENITAL TRACT
• Kidney injury - common next to spleen and liver
• Pancreatic injury - 4% cases of trauma
• Bladder - most commonly injured extra
peritoneally by shearing at the
vesico urethral junction.
- intraperitoneally by blunt force on distended
bladder
• Rupture of prostatic urethra by shear forces is
commonly seen with
haemorrhage
 CAUSES OF BLUNT
TRAUMA
1. Motor vehicle accident involving high
kinetic energy and acceleration and
deceleration- 75%
2. Direct blow to the abdomen 15%
3. Fall 6-9%
4. Child abuse
5. Domestic Violence
MECHANISM OF BLUNT TRAUMA

• The basic physical mechanisms at play with the potential of

injury to intra-abdominal organs —
• Compression : Compression from the crush between solid
objects such seat belts/steering wheel and vertebra on direct
application of blunt force. Eg: spleen
• Shearing: sudden accelaration and deceleration apply a
shearing force on the organ or blood vessel on fixed
attachment. Eg: Aorta
• Bursting: raised intraluminal pressure by abdominal compression
leads to rupture. Eg: diaphragmatic rupture, bladder injury.
 LIVER INJURY
• Liver is the second most commonly injured organ in blunt trauma abdomen .
(35-
• 45%) in BTA

• Right lobe commonly involved than left lobe.

• Posterior segment commonly involved than anterior segment.
• Caudate involvement is rare.
• Mortality rate:8-25% (uncontrolled bleeding)
• • Liver is the largest organ in abdomen
• • Driving and fighting
• • Usually venous bleeding
• • 85% of all patients with blunt hepatic trauma are stable
 SPLENIC INJURY

• Spleen lies in the posterior portion of the left quadrant deep to

ninth, tenth and eleventh ribs.
• Most commonly injured organ in blunt trauma. (40-55%)
• Injury to spleen is the most common indication for laprotomy
following blunt trauma.
• Mortality: 50-60%
• 20% of splenic injuries due to left lower rib fractures
• • Commonly arterial hemorrhage
SPLEEN AND ITS ANATOMY
BLOOD SUPPLY
 PATHOPHYSIOLOGY
Deceleration forces results in splenic motion, capsular avulsion where
spleen is leathered(splenophrenic splenorenal, splenocolic, gastrosplenic
ligaments)

Direct transmission of energy via chest wall

Puncture from adjacent rib fracture(9,10,11)

Splenic Ischemia and blood loss

 REFERENCES

• Bailey & Love Manual of Surgery(26th ed)

• Sabiston (19th ed)
• Schwartz Manual of Surgery(10th ed)
Literatures-
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3137826/

• https://journals.tbzmed.ac.ir/JARCM/Manuscript/JARCM-4-228.pdf

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3309620/

• https://www.omicsonline.org/open-access/liver-and-spleen-injuries-and-associated-rib-
fractures-an-autopsy-study-2157-7145.1000240.php?aid=30426