Abdominal Injuries

• • Mechanism of injury in blunt trauma is rapid deceleration with noncompliant organs most at risk (kidney, liver, spleen, pancreas)

Penetrating Injuries

• • 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

Blunt Injuries

• • Focused Assessment with Sonography for Trauma (FAST) exam is important management tool

  • Nonsurgical therapy used in more than 80% of blunt liver and spleen injuries

Epidemiology

• • 30% of patients with "seatbelt signs" have internal injury

  • 85% of patients with blunt liver injury stabilize with resuscitation alone

Symptoms and Signs

• • 35% of patients with hemoperitoneum may not manifest clinical signs of peritoneal irritation

  • Elevated WBC count and fever appearing several hours later

• • 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

Abdominal Wall Injuries

• • 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

Liver Injuries

• • 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 ...