Abdominal Trauma

About 30 million people are seen in the emergency rooms of America for the treatment of injuries that are nonfatal. At least 72,000 of these people were found to be disabled by their injury, costing the US billions of dollars.

The exact frequency of blunt trauma injuries to the abdomen is, unfortunately, unknown. The incidence of out of hospital deaths from abdominal trauma is also unknown.

One study looked at the National Pediatric Trauma Registry and found that 8 percent of patients were found to have abdominal trauma. Of these injuries, 83 percent were blunt force injuries and automobile accidents accounted for almost 60 percent of those who were injured. Similar findings have been seen in adult trauma registries with blunt trauma injuries accounting for about 2/3 of all injuries. About two thirds of patients with hollow viscus trauma are injured in motor vehicle accidents.

Abdominal trauma can be represented by blunt abdominal trauma or penetration trauma as can be found in gunshot injuries or knife wounds. Combat wounds are often a combination of blunt trauma and penetrating trauma.

Abdominal trauma has the tendency to be life threatening because many of the abdominal organs, especially those that reside in the retroperitoneal space, will bleed heavily. Solid organs like the liver and the kidneys can be cut and torn, leading to heavy bleeding. The aorta and the vena cava can rupture, leading to exsanguination fairly quickly. The bowels can spill fecal material all over the abdominal space. Most people who die from abdominal trauma die from systemic infection or hemorrhage.

The liver is the most vulnerable abdominal organ because it is so big and is located in the upper right-hand corner of the abdomen. With blunt abdominal trauma, you can get a lacerated or bruised liver and can get a big risk of shock from exsanguination or liver dysfunction. Often it takes emergency surgery to correct the bleeding.

The spleen is damaged the most in blunt abdominal injuries. It is the second most commonly injured organ in the abdomen of children. When the splenic capsule is damaged, one can get a hematoma within the spleen. Should the spleen rupture altogether, a life threatening hemorrhage associated with shock can occur. It is less sensitive to the shock of penetrating injuries than with the liver unless the renal artery is affected. Rib fractures are associated with splenic injury about 20 percent of the time.

The pancreas can also be injured when the abdomen is traumatized. They are often injured in bicycle injuries when the rider impacts the handlebars. Doctors look for fluid around the pancreas as an indication of an injury to the organ.

The kidneys are partially protected by the rib cage but they can still be injured. Lacerations and contusions (bruising) are possible. Bloody urine is a common sign of kidney injury and there can be leakage of urine into the abdomen.

The small intestine is the major part of the viscera to get injured in a penetrating injury of the abdomen. The biggest problem is bowel perforation with air showing up on plain film or CT scan where it doesn’t belong. A bowel injury might also be associated with a bowel obstruction or an abscess. These things require surgery.

Some patients involved in motor vehicle crashes can have a positive “seat belt” sign, revealing bruising on the abdomen where the lap part of the seat belt. This can mean that there is a high incidence of abdominal injury. Seat belts can cause injury in up to 30 percent of people with seat belt signs. Look for nausea, vomiting, blood in the urine, and fever. There is also:

• Abdominal pain
• Abdominal tenderness
• Abdominal distension
• Rigidity to the abdomen
• Lack of bowel sounds
• Abdominal guarding
• Pneumoperitoneum
• Evisceration in penetrating trauma
• Rib fractures
• Abdominal wall injury
• Vertebral injury

The presence of any of these things can lead the doctor to investigate further with x-rays, CT scan or peritoneal lavage.

Abdominal injuries can be penetrating or blunt trauma. The following are the causes of a penetrating injury:

• Gunshot injury
• Knife injury
• Combat injury with shrapnel

The following are the causes of a blunt trauma to the abdomen include:

• Automobile accidents
• Motorcycle accidents
• ATV accidents
• Falls from a height
• Altercations
• Bicycle accidents
• Child abuse

The patient presenting to the emergency room will have a thorough history and physical exam formed. If there is abdominal pain, distension or bruising, the doctor will focus on the abdomen. A plain film x-ray will be done to look for air/fluid levels indicative of ileus as well as free air in the abdomen.

A CT scan of the abdomen will tell if there are areas of hemorrhage or solid organ lacerations. The CT scan can show areas of free air in the abdomen and areas of abscess or disruption of the viscus.

An MRI exam can be done to take a look at most of the same things that can be seen on a CT exam; however, the MRI exam can show details of soft tissue injury better than the CT scan.

Before MRI and CT scans were available, there was the peritoneal lavage. In that test, the doctor would insert a needle into the abdomen and flow in fluid in the form of saline. After giving the fluid a chance to mix with abdominal fluids, the fluid is removed. If there is a significant amount of blood in the fluid, it means there is some kind of injury and surgery might be indicated. This test isn’t used as much anymore.

In the emergency room, the focus should be on the ABCs of emergency care—airway, breathing, and circulation. In the case of abdominal trauma, the only two choices are watchful waiting and surgery. Surgery is done to repair lacerations of major organs and to put together viscera. If there are areas of ruptured viscera, the patient needs to be on antibiotics and to have the area cleansed as much as possible with saline. If there are obvious signs of peritonitis, abscesses need to be cleared surgically with multiple antibiotics used to clear infection. If the area of viscera can be repaired, it usually is.

The patient with abdominal trauma may need to be evaluated in an ICU setting, especially for the first night when the changes can happen suddenly and could mean a drastic change in the course of the patient’s therapy.

If you or a loved one has suffered an abdominal injury as a result of someone else's negligence and would like to discuss your legal options with an experienced Sacramento Personal Injury Attorney, contact us online or call us at 916.921.6400 to set up a FREE consultation.