1. Abdominal Trauma
Frequent cause of preventable death
Dr. Shahzad Alam Shah
FCPS
Assistant Professor
Fatima Jinnah Medical College/Sir
Ganga Ram Hospital Lahore
Pakistan

2. OBJECTIVES
Recognizing Acute Abdomen
O
B
J Recognizing differences between the Blunt
& Penetrating abdominal injuries
E
C
T Significance of different anatomic regions
I
v
Application of the diagnostic procedures
E
S specific to abdominal trauma
Management

3. Inadequate evaluation
Inadequate diagnosis
Most common
factors leading to Inadequate volume
Death
Delayed surgery
Delayed resuscitation
Frequent cause of preventable death

4. Anatomy of Abdomen

5. Abdominal Anatomy
and Regions
Left Upper Quadrant Right Upper Quadrant
Spleen Liver
Stomach
Gall Bladder
Pancreas
Left Kidney Right Kidney
Transverse Colon Ascending Colon
Descending Colon Transverse Colon
Left Lower Quadrant Right Lower Quadrant
Descending Colon Ascending Colon
Sigmoid colon Appendix
Left Ovary (female) Right Ovary (female)
Right Fallopian Tube (female)
Left Fallopian Tube (female)

6. Abdominal Regions
•Intrathoracic Abdomen
•Pelvic Abdomen
•Retroperitoneum

7. Abdominal Anatomy
and Organ Injury
Hollow Organs Solid Organs Vascular Injury
Liver
Stomach Aorta
Spleen
Gall bladder Vena Cava
Kidney
Intestines Major Branches
Pancreas
Ureters, Bladder
Rupture causes Injured Solid organs, Injury can cause
spillage bleed heavily severe blood loss
Exsanguination
Peritonism Shock
(bleeding out)

8. Initial Assessment

9. Initial Assessment/Management:
ABCDE
 Airway with cervical spine control
 Breathing
 Circulation: Resuscitation; stop external
bleeding
 Disability
 Exposure

10. No abdominal injury have the precedence
over the initial assessment of the trauma
patients
Evisceration
With large laceration
abdominal contents
may spill out
Do not try to replace
Cover exposed organs with saline soaked dressing
Cover first dressing with second dry dressing

11. Abdominal Trauma
Management
 Maintenance of I/V line
 Draw blood for cross
matching/CBC/amylase
 Fluids
 Nasogastric tube
 Foley's Catheter
 High flow O2
 Assist ventilations if needed
 Give nothing by mouth

12. Nasogastric Tube
Removes air and fluid
Assess for bleeding
Minimize risk of aspiration
Caution --> Facial #
Foley's Catheter
Rectal / genital Exam first
Decompress bladder
Monitor urine output
Diagnostic: Hamaturia
Caution --> Pelvic #

13. Assessment of Injured Abdomen
 Pain
 Pain referred to shoulder = Organ under
diaphragm involved (?spleen)
 Pain referred to back = Retroperitoneal organ
involved (?kidney)
 Diffuse tenderness
 Abdominal Rigidity
 NOT reliable
 Bleeding may not cause rigidity
 Bleeding in retroperitoneal space may not
cause rigidity

14. Assessment
 Primary factor
To determine that an abdominal injury is present
(accurate diagnosis is not important)
Positive Exam: Significant
Negative Exam: Does not preclude injury
Negative Exam. may become +ve with time
Re-evaluate !

15. Unexplained Shock
In trauma, if there are signs of shock
and no obvious cause is present
? Abdominal injury
(Assess vital signs; skin color, temperature;
capillary refill
Tachycardia; restlessness; cool, moist skin)

16. Management
 re-establish vital functions (resuscitate)
 delineate the injury mechanism
 maintain high index of suspicion related to occult
vascular and retroperitoneal injuries
 repeat a meticulous examination, assessing for
changes
 Select special diagnostic maneuvers as needed

17. Diagnostic Maneuvers
OR
Modalities
Abdominal Ultrasound Screening Radiographs
CT Scan Contarst Studies
Diagnostic Peritoneal Lavage Diagnostic Laparoscopy

18. Trauma to
lower chest,
Pain in  Trauma to
uninjured shoulder back, flank,
Trauma to
Mechanism High Index of
Suspicion buttocks
Diffusely
Trauma to
perineum tender abdomen
Hypovolemic
shock with no readily
identifiable cause

19. Indications for Laparotomy
 Signs of Peritonitis
 BP + Evidence of Abdominal injury
• Extra luminal Air
• Injured Diaphragm
• Intraperitoneal Injury
(+ DPL or + CT)
• Persistent Amylase elevation with abdominal
findings

20. A young patient of about 30 years sustained injury in a RTA
with a bruise mark on left lower chest
Splenic
Trauma

21. A hemodynamicaly stable patient received
in ED having a single gun shot entry
wound in the left lumber area was having
frank haematuria after Cathetrization.
Renal Trauma

22. A motorcyclist had an tonga bamboo injury in the epigastrium.
What finding in the CT scan is evident
Pancreatic Trauma

23. Plain X-Ray of a patient who sustained a blunt abdominal
injury revealed absent dome of diaphragm on the left side.
Diaphragmatic Injury

24. A car driver had an head on collision with another car
brought to the emergency department. The C.T. Scan revealed.
Liver Trauma

25. KEY POINTS
 It is not always easy to recognize
peritonitis secondary to abdominal
trauma
 Less important to diagnose exact injury
 Management same regardless of specific
organ(s) injured
 No Abdominal injury has precedence
over the initial assessment

26. ?