Abdominal Trauma Seminar

Dr. Talha & Dr.
Navya
Moderator: E Surgery
 The abdomen can be injured in many types of trauma; injury may be
confined to the abdomen or be accompanied by severe, multisystem
trauma.
 The nature and severity of abdominal injuries vary widely
depending on the mechanism and forces involved
Abdominal trauma is typically categorized by
mechanism of injury:
 Blunt
ETIOLOGY  Penetrating
The spleen is the organ damaged most commonly,

followed by the liver and a hollow viscus (typically
the small intestine).
Injuries are also often categorized by the type of structure
that is damaged:
 Abdominal wall
 Solid organ (liver, spleen, pancreas, kidneys)
 Hollow viscus (stomach, small intestine, colon, ureters,
bladder)
 Vasculature
1)Rupture/Burst - sudden increase in intra-abdominal pressures.
Can have hollow viscus perforation, mesenteric tears and solid organ injuries
2)Crush - direct force to anterior wall, squishing organs between force and vertebral column
3) Acceleration/Deceleration - Sudden forces cause shear effect of organs on their pedicle,

damaging vasculature
 Penetrating trauma is an injury caused by a foreign object piercing the skin, which
damages the underlying tissues and results in an open wound.
 The most common causes of such trauma are :
GUNSHOTS
 Medium-velocity or high-velocity injuries
 Damage also caused to structures adjacent to the path of the bullet
 Dense organs (e.g., liver, spleen) undergo more damage because they absorb
more energy, resulting in greater injury.
STAB WOUNDS - Usually caused by a sharp, impaling object (e.g., knife, ice pick,
broken bottle)
 Anterior penetrating abdominal injury: An entry wound on the anterior abdomen or chest
that could have penetrated into the peritoneal cavity. Usually these injuries occur anterior to
the posterior axillary line.

 Thoraco-abdominal penetrating abdominal injury: An entry wound below the fifth
intercostal space and above the costal margin.
 Posterior or flank penetrating abdominal injury: An entry wound posterior to the

posterior axillary line.
Blunt or penetrating trauma may lacerate or
rupture intra-abdominal structures.
Blunt injury may alternatively cause only a

hematoma in a solid organ or the wall of a
hollow viscus.
If the patient survives, abdominal injuries

present clinically in one of two ways, either
as the result of haemorrhage and blood loss,
or else as following spillage of the contents
of a viscus
Delayed consequences of abdominal injury
include :
 Hematoma rupture
 Intra-abdominal abscess
 Bowel obstruction or ileus
COMPLICATIONS  Biliary leakage and/or biloma

 Abdominal compartment syndrome
 Abscess, abdominal compartment syndrome,

and delayed incisional hernia also can be
complications of treatment.
 The spleen is the most commonly injured abdominal organ, which accounts for
49% of blunt abdominal injuries
 Among patients with blunt injury, motor vehicle collision is the most
common injury mechanism.
 The liver is the second-most commonly injured organ, with an
incidence of injury that ranges from 1%-8%; how- ever, it is the most
common cause of BAT mortality
 In patients with penetrating liver injury, the severity of injury
depends upon the trajectory of the missile or implement, and injuries
can range from simple parenchymal to major vascular laceration.
 Mesenteric injury – Laceration causing an expanding hematoma that
compresses the arcades and threatens the viability of a segment of
the intestine
 Small Intestine – Mostly due to blunt trauma
 Duodenal Injuries
 Large intestine – most heavily on the cecum and a hematoma in the
wall of the organ that may lead to delayed rupture at any time upto 2
weeks after the injury
 The kidneys are the third most
commonly injured organs in BAT,
which range from 1%-5%.
 Renal laceration can be superficial
(<1 cm in depth, grades I-II) or deep
(>1 cm in depth, grade III).
ABDOMINAL
VASCULAR INJURIES
 Vascular abdominal injuries of major vessels in zone 1 abdominal cavity are the
most common cause of death after penetrating abdominal trauma.
 Abdominal arterial and vein injuries occur with the same incidence.
 Patients with retroperitoneal vascular injury and intact retroperitoneum may
present hemodynamically stable due to tamponade.
 The most common arterial lesions are partial/ incomplete transection, and
contusion of the vascular wall

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Dr. Talha & Dr.

The spleen is the organ damaged most commonly,

3) Acceleration/Deceleration - Sudden forces cause shear effect of organs on their pedicle,

 Posterior or flank penetrating abdominal injury: An entry wound posterior to the

Blunt injury may alternatively cause only a

If the patient survives, abdominal injuries

COMPLICATIONS  Biliary leakage and/or biloma

 Abscess, abdominal compartment syndrome,

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