Abdominal Trauma
In patients with abdominal trauma, ultrasound examination of the abdomen (Morrison pouch, spleen, Douglas pouch) should be done immediately after admission to exclude life-threatening abdominal injuries, and to safeguard vital organ functions.
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Wolfgang E. Thasler
Abdominal trauma is usually separated into blunt and penetrating trauma. It is important to consider the injury severity and the bleeding risk of solid organs early after trauma due to delays of initial treatment or due to missed injuries during initial assessment. For the treating surgeon, four key questions must be answered urgently: 1. Is the patient hemodynamically unstable? 2. Does ultrasound show free fluid in the abdomen (FAST scan)? 3. Which organ systems are involved with the trauma? 4. Does the patient need a laparotomy?
61.1 Epidemiology Approximately 20–30% of the patients with multiple trauma require treatment of intra-abdominal injuries. The injuries affect with decreasing frequency the liver, spleen, large bowel, genitals, peritoneum, pancreas, and diaphragm. Following blunt abdominal trauma, injury of the spleen is the most common indication for laparotomy. In 50% of cases, the intestine is injured during penetrating abdominal trauma.
mainly due to the hypovolemic shock, which in terms of bleeding control emphasizes the importance of rapid and effective treatment. When treatment is delayed, there is a significant increase of mortality. When compared to complex limb or brain injuries, few patients suffer from long-term handicaps once the initial trauma has been survived. In patients with splenic laceration, a conservative approach should be attempted if the patient is not in shock due to the lifelong risk of septic complications after the splenectomy (OPSI syndrome, see Chap. 26). Currently, 70–90% of all infant injuries and 40–50% of all adult injuries of the spleen can be treated without surgery. Due to the complex healing process and the severity of accompanying injuries, pancreatic injuries have a high mortality rate of up to 25%.
61.3 Clinical Findings, Initial Treatment, Emergency Admission 61.3.1 Blunt and Penetrating Abdominal Trauma
61.2 Prognostic Significance Polytraumatized patients with abdominal injuries, especially to the spleen and liver, have a significantly higher mortality rate within the first 24 h. This is W.E. Thasler Department of Surgery, Grosshadern Hospital, Ludwig-Maximilians-University München, Marchioninistr 15, D-81377, München, Germany e-mail: [email protected]
Clinical findings of blunt abdominal trauma usually are acute abdominal pain, caused by peritoneal irritation due to free intra-abdominal blood or a tear of the peritoneum. Pain projected into the back or genitals is usually caused by an injury of the retroperitoneal organs (pancreas, kidney). The pain intensity often does not correlate with the injury severity; however, the extent of hypovolemic shock dictates the urgency of therapeutic interventions. Bruises and pain localization give a first indication of potentially injured organs.
M.W. Wichmann et al. (eds.), Rural Surgery, DOI: 10.1007/978-3-540-78680-1_61, © Springer-Verlag Berlin Heidelberg 2011
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W.E. Thasler
A splenic injury is correlated with left lower rib fractures in ¼ of all patient
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