Abdominal trauma is an injury to the abdomen.

Signs and symptoms include abdominal

pain, tenderness, rigidity, and bruising of the external abdomen. Complications may
include blood loss and infection.
Diagnosis may involve ultrasonography, computed tomography, and peritoneal lavage, and
treatment may involve surgery.[1] It is divided into two types blunt or penetrating and may
involve damage to the abdominal organs.[2] Injury to the lower chest may cause splenic or liver
injuries.[3]

Contents

 1Signs and symptoms

 2Causes
 3Pathophysiology
o 3.1Liver
o 3.2Spleen
o 3.3Pancreas
o 3.4Kidneys
o 3.5Bowel
 4Diagnosis
o 4.1Ultrasound
o 4.2CT
o 4.3Peritoneal lavage
o 4.4Classification
 5Treatment
 6Prognosis
 7Epidemiology
 8References
o 8.1Bibliography
 9External links

Signs and symptoms[edit]

The abdominal organs

Signs and symptoms are not seen in early days and after some days initial pain is seen. People
injured in motor vehicle collisions may present with a "seat belt sign", bruising on the abdomen
along the site of the lap portion of the safety belt; this sign is associated with a high rate of injury
to the abdominal organs.[4] Seatbelts may also cause abrasions and hematomas; up to 30 percent
of people with such signs have associated internal injuries.[5] Early indications of abdominal
trauma include nausea, vomiting, blood in the urine, and fever.[4][6] The injury may present
with abdominal pain, tenderness,[7] distension, or rigidity to the touch, and bowel sounds may be
diminished or absent. Abdominal guarding is a tensing of the abdominal wall muscles to guard
inflamed organs within the abdomen. Pneumoperitoneum, air or gas in the abdominal cavity,
may be an indication of rupture of a hollow organ. In penetrating injuries,
an evisceration (protrusion of internal organs out of a wound) may be present.[8]
Injuries associated with intra-abdominal trauma include rib fractures, vertebral fractures, pelvic
fractures, and injuries to the abdominal wall.[9]

Causes[edit]
Motor vehicle collisions are a common source of blunt abdominal trauma.[5] Seat belts reduce the
incidence of injuries such as head injury and chest injury, but present a threat to such abdominal
organs as the pancreas and the intestines, which may be displaced or compressed against
the spinal column.[5] Children are especially vulnerable to abdominal injury from seat belts,
because they have softer abdominal regions and seat belts were not designed to fit them.[4] In
children, bicycle mishaps are also a common cause of abdominal injury, especially when the
abdomen is struck by the handlebars.[4] Sports injuries can affect abdominal organs such as the
spleen and kidneys.[7] Falls and sports are also frequent mechanisms of abdominal injury in
children.[4] Abdominal injury may result from child abuse and is the second leading cause of
child abuse-related death, after traumatic brain injury.[6]
Gunshot wounds, which are higher energy than stab wounds, are usually more damaging than the
latter.[10] Gunshot wounds that penetrate the peritoneum result in significant damage to major
intra-abdominal structures in some 90 percent of cases.[10]

Pathophysiology[edit]
Abdominal trauma can be life-threatening because abdominal organs, especially those in
the retroperitoneal space, can bleed profusely, and the space can hold a great deal of blood.
[11]
 Solid abdominal organs, such as the liver and kidneys, bleed profusely when cut or torn, as do
major blood vessels such as the aorta and vena cava.[11] Hollow organs such as the stomach,
while not as likely to result in shock from profuse bleeding, present a serious risk of infection,
[11]
 especially if such an injury is not treated promptly.[5] Gastrointestinal organs such as the
bowel can spill their contents into the abdominal cavity.[5] Hemorrhage and systemic infection
are the main causes of deaths that result from abdominal trauma.[5]
One or more of the intra-abdominal organs may be injured in abdominal trauma. The
characteristics of the injury are determined in part by which organ or organs are injured.
Liver[edit]
Main article: Liver injury
The liver, the most vulnerable abdominal organ to all forms of injury because of its size and
location (in the upper right quadrant of the abdomen), is injured in about five percent of all
people admitted to a hospital for trauma.[12] Liver injuries present a serious risk for shock because
the liver tissue is delicate and has a large blood supply and capacity.[11] The liver may
be lacerated or contused, and a hematoma may develop.[13] It may leak bile, usually without
serious consequences.[13] If severely injured, the liver may cause exsanguination (bleeding to
death), requiring emergency surgery to stop the bleeding.[9]
Spleen[edit]
Spleen is the most common cause of massive bleeding in blunt abdominal trauma to a solid
organ. Spleen is the most commonly injured organ. A laceration of the spleen may be associated
with hematoma.[13] Because of the spleen's ability to bleed profusely, a ruptured spleen can be
life-threatening, resulting in shock. However, unlike the liver, penetrating trauma to the spleen,
pancreas and kidneys do not present as much of an immediate threat of shock unless they
lacerate a major blood vessel supplying the organs, such as the renal artery.[5] Fractures of the left
lower ribs are associated with spleen lacerations in 20 percent of cases.[9]
Pancreas[edit]
The pancreas may be injured in abdominal trauma, for example by laceration or contusion.
[4]
 Pancreatic injuries, most commonly caused by bicycle accidents (especially by impact with the
handlebars) in children and vehicular accidents in adults, usually occur in isolation in children
and accompanied by other injuries in adults.[4] Indications that the pancreas is injured include
enlargement and the presence of fluid around the pancreas.[4]
Kidneys[edit]

A large hematoma (closed arrow) of the left kidney (open arrow)

The kidneys may also be injured; they are somewhat but not completely protected by the ribs.
[6]
 Kidney lacerations and contusions may also occur.[13] Kidney injury, a common finding in
children with blunt abdominal trauma, may be associated with bloody urine.[13] Kidney
lacerations may be associated with urinoma or leakage of urine into the abdomen.[4] A shattered
kidney is one with multiple lacerations and an associated fragmentation of the kidney tissue.[4]
Bowel[edit]
The small intestine takes up a large part of the abdomen and is likely to be damaged in
penetrating injury.[5] The bowel may be perforated.[4] Gas within the abdominal cavity seen on
CT is understood to be a diagnostic sign of bowel perforation; however intra-abdominal air can
also be caused by pneumothorax (air in the pleural cavity outside the lungs that has escaped from
the respiratory system) or pneumomediastinum (air in the mediastinum, the center of the chest
cavity).[4] The injury may not be detected on CT.[4] Bowel injury may be associated with
complications such as infection, abscess, bowel obstruction, and the formation of a fistula.
[4]
 Bowel perforation requires surgery.[4]

Diagnosis[edit]
Pneumoperitoneum, seen as an air bubble on the lower left side of the X-ray film

CT scan showing the liver and a kidney

Ten percent of people with polytrauma who had no signs of abdominal injury did have evidence
of such injuries using radiological imaging.[1] Diagnostic techniques used include CT
scanning, ultrasound,[1] and X-ray.[7] X-ray can help determine the path of a penetrating object
and locate any foreign matter left in the wound, but may not be helpful in blunt trauma.
[7]
 Diagnostic laparoscopy or exploratory laparotomy may also be performed if other diagnostic
methods do not yield conclusive results.[5]
Ultrasound[edit]
Ultrasound can detect fluid such as blood or gastrointestinal contents in the abdominal cavity,
[1]
 and it is a noninvasive procedure and relatively safe.[4] CT scanning is the preferred technique
for people who are not at immediate risk of shock, but since ultrasound can be performed right in
an emergency room, the latter is recommended for people who are not stable enough to move to
CT scanning.[1] A normal ultrasound does not rule out all injuries.[14]
CT[edit]
People with abdominal trauma frequently need CT scans for other trauma (for example, head or
chest CT); in these cases abdominal CT can be performed at the same time without wasting time
in patient care.[4]
CT is able to detect 76% of hollow viscous injuries so people who have negative scans are often
observed and rechecked if they deteriorate.[15] However, CT has been demonstrated to be useful
in screening people with certain forms of abdominal trauma in order to avoid unnecessary
laparotomies, which can significantly increase the cost and length of hospitalizations.[16] A meta-
analysis of CT use in penetrating abdominal traumas demonstrated sensitivity, specificity and
accuracy >= 95%, with a PPV of 85% and an NPV of 98%.[17] This suggests that CT is excellent
for avoiding unnecessary laparotomies but must be augmented by other clinical criteria to
determine the need for surgical exploration (23.37 positive likelihood ratio, 0.05 negative
likelihood ratio).
Peritoneal lavage[edit]
Diagnostic peritoneal lavage is a controversial technique but can be used to detect injury to
abdominal organs: a catheter is placed in the peritoneal cavity, and if fluid is present, it is
aspirated and examined for blood or evidence of organ rupture.[1] If this does not reveal evidence
of injury, sterile saline is infused into the cavity and evacuated and examined for blood or other
material.[1] While peritoneal lavage is an accurate way to test for bleeding, it carries a risk of
injuring the abdominal organs, may be difficult to perform, and may lead to unnecessary surgery;
thus it has largely been replaced by ultrasound in Europe and North America.[1]
Classification[edit]
Abdominal trauma is divided into blunt and penetrating types. While penetrating abdominal
trauma (PAT) is usually diagnosed based on clinical signs, diagnosis of blunt abdominal trauma
is more likely to be delayed or altogether missed because clinical signs are less obvious.[1] Blunt
injuries predominate in rural areas, while penetrating ones are more frequent in urban settings.
[5]
 Penetrating trauma is further subdivided into stab wounds and gunshot wounds, which require
different methods of treatment.[7]

Treatment
Initial treatment involves stabilizing the patient enough to ensure adequate airway, breathing,
and circulation, and identifying other injuries.[7] Surgery may be needed to repair injured organs.
Surgical exploration is necessary for people with penetrating injuries and signs of peritonitis or
shock.[5] Laparotomy is often performed in blunt abdominal trauma,[1] and is urgently required if
an abdominal injury causes a large, potentially deadly bleed.[5] The main goal is to stop any
sources of bleeding before moving onto any definitive find and repair any injuries that are found.
[18]
 Due to the time sensitive nature, this procedure also emphasizes expedience in terms of
gaining access and controlling the bleeding, thus favoring a long midline incession.[19] Intra-
abdominal injuries are also frequently successfully treated nonoperatively[7][4] as there is little
benefit shown if there is no known active bleeding or potential for infection.[20] The use of CT
scanning allows care providers to use less surgery because they can identify injuries that can be
managed conservatively and rule out other injuries that would need surgery.[7] Depending on the
injuries, a patient may or may not need intensive care.[4]

Prognosis
If abdominal injury is not diagnosed promptly, a worse outcome is associated.[1] Delayed
treatment is associated with an especially high morbidity and mortality if perforation of the
gastrointestinal tract is involved.[13]

Epidemiology
Most deaths resulting from abdominal trauma are preventable;[5] abdominal trauma is one of the
most common causes of preventable, trauma-related deaths.