Abdominal Trauma

Abdominal Trauma's Causes, Diagnosis, and Treatment | Force Blunt TraumaIn this article:

• What Percentage of Accident Victims Suffer From Abdominal Injuries?
• What is Abdominal Blunt Force Trauma?
• What are the Organs Affected by Force Blunt Trauma to the Abdomen?
• What are the Symptoms of Abdominal Injury?
• What are the Causes of Abdominal Injury?
• Diagnosis of Abdominal Injury
• Treatment of Abdominal Injuries

What Percentage of Accident Victims Suffer From Abdominal Injuries?One study looked at the National Pediatric Trauma Registry and found 8 percent of patients had abdominal injuries. 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. With these findings, it's really important for the force blunt trauma victims to seek professional help from personal injury lawyers to settle their cases. 

What is Abdominal Blunt Force Trauma?Abdominal trauma can be represented by blunt force trauma to the abdomen or penetration trauma such as those found in gunshot injuries or knife wounds. Combat wounds are often a combination of blunt trauma and penetrating trauma. This force blunt trauma to the abdomen has the tendency to be life-threatening because many of the abdominal organs, especially those that reside in the retroperitoneal space, will bleed heavily in this type of injury.

What are the Organs Affected by Force Blunt Trauma to the Abdomen?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 fair 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. Here are the other organs affected by this type of trauma:

• Liver: The liver is the most vulnerable abdominal organ, because it is so big and located in the upper right-hand corner of the abdomen. With blunt abdominal trauma, you can get a lacerated or bruised liver and increase your risk of shock from exsanguination or liver dysfunction. Often, it takes emergency surgery to correct the bleeding.
 
• Spleen: The spleen is damaged most often 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.
 
• Pancreas: 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.
 
• Kidneys: 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.
 
• Small Intestine: 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.

What are the Symptoms of Abdominal Injury?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 is. 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 are also the following abdominal injury symptoms:

• Abdominal pain and 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

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

What are the Causes of Abdominal Injury?Abdominal injuries can be penetrating or force blunt trauma. To help you identify the two, below are the lists of causes of a penetrating trauma and a force blunt trauma.Causes of a Penetrating Trauma

• Gunshot injury
• Knife injury
• Combat injury with shrapnel

Causes of a Force Blunt Trauma to the Abdomen

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

Diagnosis of Abdominal InjuryA patient at 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 performed to look for air/fluid levels indicative of ileus as well as free air in the abdomen. Here are the other procedures to diagnose abdominal injuries:

• CT Scan: 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.
 
• MRI Exam: 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.
 
• Peritoneal Lavage: 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 needed. This test isn’t used as much anymore.

Treatment of Abdominal InjuriesIn 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. Also, if there are obvious signs of peritonitis, abscesses need to be cleared surgically with multiple antibiotics to clear the infection.