Blunt abdominal traumas are indicative of serious intra-abdominal pathology. Some injuries do not manifest during the initial assessment of the patient. With deceleration there is rapid movement of the internal organs due to blunt force. Usually a tear in the ligamentum teres is noticed besides injuries to the renal arteries. The intra-abdominal organs are crushed between the vertebral column and the abdominal wall. Blunt abdominal traumas are attributed to auto collisions, falls, industrial accidents and recreational accidents.
Penetrating abdominal trauma essentially requires surgical management. The abdominal cavity is violated with close-range injuries transferring more kinetic energy. The pattern of injuries is unpredictable due to high energy transfers.
Indications for blunt abdominal trauma surgery
Patient may display signs of peritonitis and uncontrolled haemorrhage. Diagnostic peritoneal lavage examination will reveal haemoperitoneum findings. The evidence of peritonitis is indicative of surgical treatment. FAST along with CT scan shows the extent of injuries. A positive FAST scan is always an indication for surgery. A rapid primary survey of the patient’s condition and reassessment of the airway is done upon patient’s arrival. The cervical spine is immobilized for protection and nasotracheal or endotracheal intubation is carried out. Circulatory status is assessed and any external haemorrhage is controlled. Once haemodynamic stability is achieved, further treatment is prepared.
Indications for penetrating abdominal trauma surgery
Patient presents with increasing abdominal pain. Peritoneal findings will indicate point tenderness, rebound tenderness and involuntary guarding. Patient also experiences diffuse localized pain, which is unresolved along with haemodynamic instability. Blood, urine studies, plain radiographs and CT scans are conducted for patient evaluation. Triple-contrast CT scans produce high accuracy rates. Obvious intraperitoneal organ injury is noted.
Technique (penetrating abdominal trauma)
Control of bleeding, identifying injuries, contamination control and reconstruction are essential components of a trauma laparotomy.
Bleeding control is accomplished with laparotomy pads
The abdominal wall is retracted
The falciform ligament is taken down
Liver and spleen are covered with packs
Anaesthesia is administered
Time is given to catch-up with fluid resuscitation
Staples and suture closures will ensure contamination control
A reconstruction is performed once the patient is stabilized
Damage-control surgeries are performed when patients develop metabolic acidosis and coagulopathy. Techniques may include perihepatic packing with towel clip closure of the abdomen; therapeutic decompressive celiotomy and leaving the abdominal fascia open after a laparotomy for prophylactic purposes.
Dr. Deepak and his team are well-equipped to handle emergency abdominal trauma surgeries. Established codes of procedures are observed for such treatments.