//fpnotebook.com/
Abdominal Trauma
Aka: Abdominal Trauma, Abdominal Injury- See Also
- Causes: Blunt Abdominal Trauma
- Direct blow to the Abdomen (e.g. Contact Sports, Motor Vehicle Accident)
- Fall from Height
- Cycling handlbar injury
- Associated Conditions
- Liver Laceration
- Splenic Rupture
- Renal Injury
- Pancreatic Injury
- Hollow viscus (bowel perforation) or Lumbar Spine Injury
- Seat Belt
- Deceleration injury
- Rectum or other bowel injury
- Gastrointestinal Bleeding
- Indications: Diagnostic Testing
- See precautions below
- Do not delay an exploratory laparoscopy that is clearly indicated
- Suspected occult internal bleeding with decreasing Hematocrit and no obvious source
- Non-diagnostic examination with higher clinical suspicion
- Equivocal peritoneal signs with abdominal tenderness and guarding
- Altered Level of Consciousness and suspected Abdominal Trauma
- Negative abdominal exam but high level of suspicion based on mechanism of injury
- Bony Fracture with associated abdominal tenderness or guarding
- Multiple lower Rib Fractures
- Lumbar transverse process Fracture
- Pelvic Fracture
- See precautions below
- Symptoms
- Persistent Abdominal Pain after injury
- Pain may be referred to the Shoulders
- Fever
- Nausea
- Vomiting
- Bright Red Blood Per Rectum
- Persistent Abdominal Pain after injury
- Signs
- Localized Abdominal Pain
- Abdominal guarding
- Abdominal Rebound Tenderness
- Abdominal rigidity
- Examination
- Evaluate for peritonitis or hemodynamic instability
- Complete abdominal exam
- Rectal examination
- Decreased rectal tone (Spinal Injury)
- High riding Prostate (Urethral transection)
- Bloody stool on rectal exam
- Imaging: First-line studies
- FAST Exam
- CT Abdomen and Pelvis
- Perform with IV contrast
- Consider oral and rectal contrast if time allows and not contraindicated
- Identifies Stomach and intestinal rupture
- Imaging: Abdominal XRay
- Rarely useful beyond demonstrating free air compared with CT Abdomen
- Evaluate with CT Abdomen and Pelvis (or UGI with gastrograffin) if red flags are positive
- General suspicious KUB findings
- Duodenum or pacreas injury signs
- Psoas shadow absent
- Retroperitoneal gas
- Linear air shadows at duodenum or overlying the right Kidney
- Splenic Injury signs
- Splenic shadow absent
- Gastric air bubble displaced medially
- Left psoas and left renal shadows obscured
- Left upper quadrant soft tissue density
- Diagnostics
- Diagnostic Peritoneal Lavage (not recommended)
- Rarely performed now in United States where Ultrasound and CT Scans are readily available
- Typically FAST Exam followed by CT Abdomen and Pelvis is performed in Trauma
- Diagnostic Peritoneal Lavage (not recommended)
- Precautions
- Do not delay emergent exploratory laparotomy when indicated
- Peritoneal cavity extends well into chest
- Anterior superior diaphragm boundary: Nipple Line
- Posterior superior diaphragm boundary: 4th intercostal space
- Although distracting injury may theoretically hide abdominal findings on exam, it still has 90% Test Sensitivity
- Manage secondary conditions
- Hemorrhagic Shock
- Peritonitis
- Broad spectrum antibiotic coverage for intraabdominal infection
- Sepsis management including Intravenous FluidResuscitation
- Management: Exploratory Laparotomy Indications
- Unexplained shock
- Visceral Trauma (e.g. evisceration)
- Gastrointestinal Bleeding
- Blood in Stomach
- Blood aspirated via Nasogastric Tube
- Rectal Bleeding
- Peritoneal signs on examination
- Abdominal Distention
- Absent bowel sounds
- Peritonitis
- Suspicious findings on adominal XRay or CT Abdomen (e.g. Abdominal free air)
- Retained Foreign Body into the peritoneal cavity
- All abdominal gun shot wounds should be surgically explored
- Stabbing weapon
- References
- (2012) ATLS Manual, 9th ed, American College of Surgeons
- Dreis (2020) Crit Dec Emerg Med 34(7):3-21