GI
Abdominal Trauma
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Abdominal Trauma
, Abdominal Injury
See Also
Pediatric Blunt Abdominal Trauma
Trauma Evaluation
Causes
Blunt Abdominal Trauma
Direct blow to the
Abdomen
(e.g.
Contact Sport
s,
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 Fracture
s
Lumbar transverse process
Fracture
Pelvic Fracture
Symptoms
Persistent
Abdominal Pain
after injury
Pain may be referred to the
Shoulder
s
Fever
Nausea
Vomiting
Bright Red Blood Per Rectum
Signs
Localized
Abdominal Pain
Abdominal guarding
Abdominal
Rebound Tenderness
Abdominal rigidity
Examination
Evaluate for peritonitis or hemodynamic instability
Fever
Hypotension
Tachycardia
Complete abdominal exam
Rectal examination
Decreased rectal tone (
Spinal Injury
)
High riding
Prostate
(
Urethra
l 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
Gene
ral suspicious KUB findings
Peritoneal free air mandates emergent laparoscopy
Ileus
Visceral displacement
Lumbar compression
Fracture
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
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
Rostas (2015) J Trauma Acute Care Surg 78(6):1095-100 +PMID:26151507 [PubMed]
Manage secondary conditions
Hemorrhagic Shock
Peritonitis
Broad spectrum antibiotic coverage for intraabdominal infection
Sepsis
management including
Intravenous Fluid
Resuscitation
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
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