Abdominal Trauma and Complications

Abstract

The abdomen, including pelvis, is injured in 10 to 15% of significantly injured patients: 80% by blunt and 20% by penetrating mechanisms. Abdominal injuries can be subtle and hence missed. The majority of injuries, if detected early, can be treated, and hence, delay in diagnosis or underappreciation of the severity of intra-abdominal injury is responsible for significant preventable morbidity and even mortality. The initial management is the same as any trauma patient, with the greatest threats to life addressed first. If the patient is in shock and the source is intra-abdominal, urgent laparotomy is indicated along with damage control resuscitation. If the patient remains in shock in the operating room, abbreviated damage control laparotomy should be pursued. In stable patients with penetrating mechanism, if the penetration extends into the peritoneal cavity, operative exploration to identify and address any injury is the safest approach; however, more selective approaches are increasingly being pursued. In stable patients with blunt mechanism, a thorough evaluation, usually including IV contrast-enhanced CT (CECT) is pursued to diagnose, and equally importantly, exclude intra-abdominal injury. High-quality IV CECT has a very high negative predictive value for intra-abdominal injuries. In stable patients, injuries to spleen, liver, and kidney, irrespective of grade, are managed nonoperatively with or without angioembolization. Lower-grade pancreatic injuries are managed nonoperatively or with drainage, whereas higher-grade injuries (involving major ducts) usually require resection. Majority of gastrointestinal hollow viscus injuries are managed with repair, resection with anastomosis or diversion. Delays as short as 8 hours in definitive management of such injuries increase morbidity and mortality. Intra and retro peritoneal genitourinary injuries are repaired and extraperitoneal ones are managed without surgery. Retroperitoneal hematomas are managed based on mechanism, stability, and location. Abdominal trauma is associated with a host of complications that need to be detected early and managed appropriately to prevent delayed morbidity and mortality. This review contains 5 figures, 6 tables, and 60 references. Key Words: abdomen, complications, damage control, diaphragm, hollow viscus, trauma, solid organ, retroperitoneum