Abdominal Injuries

Thomas M. Scalea Sharon A. Boswell pathophysiology., oLIníury

BluntTrauma

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Solid., y.i.s.c.eral..I.níu.ries Hollow..visceral ..Injuries Retroperitoneal ..Injuries DiaphraqmatiC..Injuries Abdominal Evaluation. .AfterBlunt..Trauma who.Needs ..Evaluation? Techniques...of .Evaluation physical ..Examination Plain.. Radiographs

Screening. .Examinations. .foLAMominaL Injury Organ-Specific. Diagnosis

Evaluation of the. Abdomen. .AftelPenetrating..Trauma Staib..Woundis

GunshotWounds

Therapy ..fo.r..Abdo,minai. Injury Laparotomy

N.o.n.operatiye.Management..of..B.!Mnt .Trauma Nonoperative ..Manage.me.ni.oi .Hepatic .Injury

Non,operati.ve, ..ManagementM .Splenic. .Injury

Chapter References

The evaluation of patients with abdominal injury cannot occur in a vacuum. It must be part of the systematic trauma evaluation designed to identify immediately life-threatening injuries and treat them first. Injuries that are potentially life-threatening can then be diagnosed in rank priority, allowing for the formation of a definitive plan of care.

Abdominal evaluation presents special challenges. There are five body cavities in which patients may be injured and sequester a significant volume of blood: the thorax, the abdomen, the retroperitoneum, muscle compartments, and "the street." A chest x-ray can easily diagnose intrathoracic blood loss. A pelvic film will diagnose pelvic fractures, the presence of which correlates strongly with retroperitoneal bleeding. External blood loss must be estimated based on prehospital provider information. The abdomen is a large body cavity, and patients can easily lose virtually their entire blood volume into it. There are no radiographic markers, and physical examination can be imprecise in the diagnosis of intraabdominal injury. Patients with missed injuries may not become symptomatic for 7 to 10 days postinjury, long after they are discharged home.

The management of intraabdominal injury continues to evolve. There are now many more injuries treated nonoperatively than there were 5 or 10 years ago. There continues to be debate as to which patients are safe for nonoperative management. Successful implementation of this strategy is contingent on accurate diagnostics and appropriate clinical follow-up.

The purpose of this chapter is to discuss the various issues concerning abdominal trauma. Clearly no one chapter can provide an indepth discussion of the multiplicity of issues concerning the evaluation and treatment of injury to the abdomen. It is our hope that we will be able to delineate these issues and provide the framework for clinical decision making when treating an injured patient.

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