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Abdominal Trauma

Injury to the abdomen is termed as abdominal trauma. Abdominal organs are damaged due to trauma. Abdominal trauma is of two types’ blunt trauma and penetrating trauma.

Blunt abdominal trauma

A collision between an external environment and the abdomen of the individual leads to intra-abdominal injuries. Rapid deceleration causes movement among structures shearing them, leading to tearing at fixed points of attachment. Classic deceleration leads to hepatic tears and injury to the renal arteries.

Causes

One of the major causes of blunt trauma is vehicular collision. Other causes are associated with industrial accidents and in rare cases iatrogenic trauma when manual thrusts are used to clear the airway during cardiopulmonary resuscitation.

Signs and Symptoms

  • Abdominal pain
  • Peritoneal irritation
  • Gastrointestinal hemorrhage
  • Tenderness
  • Hypovolemia
  • Accumulation of large amounts of blood in the peritoneal cavity

Diagnosis

Physical examination reveals:

  • Abdominal distention
  • Doughy consistency on palpation
  • Ecchymosis at the flanks also known as Grey Turner Sign
  • Umbilical ecchymosis or Cullen Sign
  • Lap belt marks for rupture of the small intestine
  • Contusions
  • Lower thoracic cage crepitation

Blood studies will include:

  • CBC
  • Serum electrolyte measurements
  • Serum glucose measurements
  • Liver function tests
  • Serum lipase and amylase measurements
  • Arterial blood gas measurements
  • Coagulation profile
  • Diagnostic urinalysis
  • Chest and pelvic radiographs
  • Abdominal ultrasonography
  • CT scan for source of hemorrhage
  • Diagnostic laparoscopy for diaphragmatic injuries
  • Peritoneal lavage to analyze the contents of the abdomen
  • Penetrating abdominal trauma

A penetrating abdominal trauma is usually caused by a gunshot wound or a knife wound. The wound can be in the areas of the anterior abdomen, intrathoracic abdomen, the flank and the back. The commonly injured organs are the colon, liver, small bowel, and the abdominal vascular structures.

Categories / signs and symptoms

Patients arriving with penetrating abdominal trauma are classified as:

Pulseless – where there is a major vascular injury

Haemodynamically unstable – where the injury is a solid organ injury and vascular injury with hemorrhaging from other sites

Haemodynamically stable – where there is a hollow viscus injury – renal or pancreatic

Diagnosis

Physical examination for the haemodynamic status of the patient is done. Vital signs of the patient are assessed, and inspection of all body surfaces is done. Local wound exploration is imperative in all cases.

Blood tests will include:

  • CBC
  • Electrolyte levels
  • BUN
  • Prothrombin time and activated partial thromboplastin time
  • Calcium and phosphate levels
  • Arterial blood gas
  • Venous lactate levels
  • Serum toxicology screen
  • Urinalysis
  • Chest radiographs
  • Ultrasound
  • CT scan
  • Skeletal survey of fractures
  • Retrograde urethrogram
  • Intravenous pyelography
  • Diagnostic peritoneal lavage
  • Tube thoracostomy
  • Laparoscopy for evaluation of the abdominal cavity

Treatment

Blunt abdominal injuries require patient breathing and circulation stabilization before surgical therapy. In a penetrating trauma after thorough diagnosis and examination, the patient is administered IV fluids, and the wounds are debrided. Surgery may have to be recommended depending on the patient status.

Dr. Deepak treats all abdominal injury emergencies after thorough assessment and examination of the patient. Strict protocols are observed in all cases.

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