Abdominal

• Traumatic injuries to the abdomen can occur from blunt forces like shearing from rapid deceleration, or penetrating mechanisms like gunshot or stab wounds
• Most commonly injured organs:

  • Spleen
  • Liver
  • Intestine
  • Major abdominal vascular most commonly injured in penetrating injuries
• Life-threatening injuries:

  • Intraabdominal haemorrhage
  • Retroperitoneal haemorrhage
  • Intraabdominal visceral organ injury
  • Unstable pelvic fracture
  • Diaphragmatic injury
• Ecchymosis over the periumbilical region, also called Cullen's sign, or on both flanks, also called the Grey-Turner sign respectively signify intraperitoneal and retroperitoneal haemorrhage from pancreatic injury.
• Referred pain to the left shoulder when palpating the left upper quadrant is Kehr's sign, which indicates splenic injury irritating the left hemidiaphragm.
• A seat belt sign is a diagonal ecchymosis across the abdomen in the distribution of a seatbelt, and this clues towards small bowel injury or a transverse fracture of the L3 vertebrae, also called a Chance fracture.
• Prophylactic antibiotics are given for penetrating abdominal trauma or when a hollow viscus such as the bowel is injured
• If they’re hemodynamically unstable, and the FAST exam shows free fluid, they should immediately get an exploratory laparotomy.
• If a patient is clinically stable and the FAST scan shows free fluid, they should receive a CT scan
• IV tranexamic acid should be given if suspected active bleeding (no more than 3 hours after injury)
• Intraabdominal haemorrhage:

  • Most commonly from the liver or spleen
  • Signs of haemorrhagic shock
  • Signs on palpation - distension, diffuse tenderness, guarding
  • Seatbelt sign
  • eFAST scan +/- CT
• Retroperitoneal haemorrhage:

  • Damage to retroperitoneal organs - kidneys, aorta, inferior vena cava, parts of the duodenum and colon
  • Because the retroperitoneum is not a confined space - it can hold a significant amount of blood
  • Signs of haemorrhagic shock
  • Often no signs of abdominal distension
  • May be Grey Turner Sign
  • No or minimal free fluid on eFAST scan
  • CT scan with contrast
• Management:

  • Conservative only if stable
  • Interventional radiology with intra-arterial embolization or stent-grafting
  • Surgical - open exploratory laparoscopy, packing, aortic clamping, ligation of vessels
• Urinalysis can be done to detect blood if GU injury is suspected
• A rigid abdomen is due to leak of bowel contents into the peritoneum from a hollow viscus injury.
• Flank injuries may produce retroperitoneal injury to the kidneys or bowel without any initial symptoms. Damage to this area should prompt a search for such injuries