Injury to any region of the abdomen can of course create injury to any of the organs contained therein. Image 3: The great vessels of the abdomen and pelvis Abdominal Anatomy

Image 2: The retroperitoneum and the structures contained within it Image 1: The layout of the intra-abdominal contents The abdominal contents can be divided into:ĭetailed anatomical knowledge will enable an accurate appreciation of likely organ damage. Injury to intraperitoneal structures should be considered when evaluating any injury which occurs between the nipple line and the pelvis.ĭetailed anatomical knowledge of the abdomen is central in enabling the clinician to systematically assess patients with abdominal trauma and predict likely sites of injury. The spleen and liver are the most commonly injured intraperitoneal organs in blunt trauma. Recognition and understanding of these patterns will aid subsequent assessment. There are a number of classical injury patterns, which occur following common mechanisms of injury such as rapid deceleration while wearing a lap-only seat belt, or after direct impact with a car steering wheel. It has greater mortality than penetrating as there is often injury to multiple organ systems. Blunt Traumaīlunt abdominal trauma commonly results from either a compression force or a deceleration injury. Stab wounds traverse adjacent abdominal structures and most commonly involve the liver (40%), small bowel (30%), diaphragm (20%), and colon (15%). The peritoneal cavity is not breached in 25% of cases. In a physiologically normal patient without signs of peritonism, wound exploration should only be undertaken by an experienced surgeon, ideally in theatre.Īpproximately 50% of penetrating abdominal injuries damage intraperitoneal structures. Unless the injury is trivial, all patients should be admitted to hospital for observation even if no further investigation is initially required.ĭo not remove any object remaining in the wound, such as a knife, as this may be tamponading underlying vessels. Patients with penetrating injury, even with normal vital signs, should be assessed by a senior surgeon. It is impossible to tell from the appearance of a surface wound, the extent of underlying damage.Ĭaution is required in assessment of penetrating abdominal wounds. High-energy gunshot wounds transfer more kinetic energy, causing increased damage surrounding the track of the missile due to temporary cavitation.¹ Stab wounds and low-energy gunshot wounds cause tissue damage by lacerating and tearing. The visible wound may be small and insignificant in appearance.

The site of entry, direction of the injury and the size and nature of the penetrating item will all provide information regarding the underlying injuries. In the UK, this is most commonly knife-related injury. In penetrating trauma, the injuries sustained are caused by direct injury as the penetrating item passes through the organs and tissues in its path. Death may be prevented if intervention occurs early. Unrecognised abdominal injury remains a significant cause of death. To aid initial diagnosis, investigation and management, abdominal trauma can be broadly grouped into penetrating or blunt, depending on the mechanism of injury. The presence of associated injuries, such as head injury with altered conscious level, spinal injury with neurological sequelae or adjacent chest or pelvic injuries, further complicates clinical evaluation. A high index of suspicion is constantly required to recognise occult injury. Serious intra-abdominal injuries may initially appear to be innocuous and localisation of symptoms is variable. The assessment of abdominal trauma is notoriously difficult.

An understanding of the physiology of hypovolaemia and shock, and the body’s response to pain and injury.

A good knowledge of the anatomy of the abdomen and the organ systems contained within.

If you are working in a department where the most appropriate services are not available on site, it is crucial to start thinking early about how best to access those required.īefore commencing this session you should have: The imaging services, radiological interventions and surgical capabilities will vary between a regional trauma centre and a district general hospital. It is a good idea to be familiar with the trauma services available in your hospital. It should enable you to think ahead and try to predict what underlying intra-abdominal injuries a patient may have sustained. This session will give you a plan for the initial assessment and management of abdominal trauma.

Author: Marie-Clare Harris / Editor: Marie-Clare Harris / Reviewer: Mehdi Teeli / Codes: C3AP1b, CAP1, CMP3, HAP1, HMP3 / Published:

Signs of abdominal bleeding from trauma