Trauma to the abdomen

ABDOMINAL INJURY
The abdomen is a diagnostic black box.
The presence of abdominal rigidity or hemodynamic compromise is an indication for prompt surgical exploration.
Abdominal trauma may occur as a result of either blunt or penetrative injury.
Many patients have associated chest, skeletal and head injuries, and cooperation with all specialists involved is essential.
Assessment, and initial management, along the principles of the Advanced Trauma Life Support system (ATLS) is important, and should ensure that other relevant injuries are not overlooked.
Blunt trauma includes direct blows, crushing injuries, blast and deceleration forces.

The history of the mechanism of injury is important in predicting the likely pattern of internal damage.
Penetrating trauma includes knife and bullet wounds and, again, the pattern of damage varies with the object which has penetrated the abdomen.
In gunshot injuries, the velocity of a bullet is also important .

The abdominal cavity is most frequently breached from an external wound in the anterior abdominal wall, but entry into the peritoneal cavity and damage to intra- abdominal organs can also occur from penetrating wounds in the thorax, the loin, the buttock or the perineum.

The traditional teaching was that all penetrating trauma of the abdomen should be explored, whereas blunt injury could be observed and a laparotomy performed if there was any evidence of peritonitis or intraperitoneal bleeding.

The decision to proceed to laparotomy following abdominal trauma is based on clinical judgement, often supplemented by imaging and peritoneal lavage.