Trauma to Abdomen - Emergency Management

Trauma to Abdomen

·        Injuries may be blunt or penetrating

·        Do a diagnostic peritoneal lavage (DPL) to look for bleeding

·        A surgeon must evaluate all penetrating injuries of the abdomen.

·        Intra abdominal visceral damage must be strongly suspected following blunt trauma to the abdomen. Multiple injuries are common and signs and symptoms guide diagnosis. Note that distracting injuries (eg fractures) may mask abdominal symptoms.

Indications for surgery

·        Unstable patient

·        Injury penetrates peritoneum

·        Significant pancreatic injury on CT

·        Significant splenic injury in an older patient

·        Arterial injury

Specific Injuries

·        Ruptured spleen (intraperitoneal haemorrhage)

o   Signs and symptoms: May be pain free, may have signs of blood loss

o   Treatment: Splenectomy if elderly otherwise try to preserve it

·        Ruptured liver: Treatment: Laparotomy and suturing individual vessels/ packing etc.

·        Ruptured gut: Presence of gas under diaphragm on x-ray, or history of penetrating wound needs laparotomy and repair/resection of affected bowel