• Mechanism of injury in blunt trauma is rapid deceleration with noncompliant organs most at risk (kidney, liver, spleen, pancreas)
• May cause sepsis if a hollow viscus is penetrated
• Severe and early shock if major vessel or liver is involved
• Injuries of the kidney, spleen, or pancreas do not usually bleed massively unless a major vessel is involved
• Do not obtain CT scan in an unstable patient
• CT has primary role in defining the location and magnitude of intra-abdominal injuries related to blunt trauma
• Diagnostic laparoscopy has an important role in cases of penetrating abdominal trauma
• Exploratory laparotomy has 3 main indications following blunt injury: peritonitis, unexplained hypovolemia, and the presence of other injuries know to be associated with intra-abdominal injuries
• Local wound exploration may rule out peritoneal penetration
• FAST exam used to identify abnormal collections of blood or fluid and obviates need for diagnostic peritoneal lavage (DPL)
• CT is noninvasive, qualitative, sensitive, and accurate for the diagnosis of intra-abdominal injury
• Caused by blunt trauma are most often due to shear forces that devitalize the subcutaneous tissue and skin; debridement is necessary to avoid serious infection
• Caused by penetrating trauma, debridement and irrigation may be necessary
• Control hemorrhage at laparotomy
• Initial techniques to control hemorrhage include manual compression, perihepatic packing, and Pringle maneuver
• Do not use Pringle maneuver for more than 1 hour
• Hepatic bleeding can be controlled by suture ligation or clip application
• Electrocautery or the argon beam coagulator can be used to control bleeding from the raw surface of the liver
• Microfibrillar collagen or hemostatic thrombin soaked gel foam can be applied to bleeding areas with pressure
• Fibrin glue can be used to treat superficial and deep liver lacerations
• If massive blood loss has already occurred at time of surgery, consider packing the liver and reexploring in 24-48 hrs
• Rarely, selective hepatic artery ligation, resectional debridement, or hepatic lobectomy may be required to control hemorrhage
• Drains should always be used
• Decompression of the biliary system is contraindicated
• Suspect hepatic vein injuries when the Pringle maneuver fails to stop hemorrhage; mortality is very high
• Nonoperative management ...
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
AccessSurgery Full Site: One-Year Subscription
Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.
Pay Per View: Timed Access to all of AccessSurgery
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.