Title: Abdominal Trauma: Blunt or penetrating • LITFL • CCC Trauma
Headings: Abdominal Trauma: Blunt or penetrating
Abdominal Trauma: Blunt or penetrating
Reviewed and revised 21 December 2015
OVERVIEW
BLUNT ABDOMINAL INJURY
PENETRATING ABDOMINAL INJURY
ASSESSMENT OF BLUNT ABDOMINAL TRAUMA
IMAGING IN BLUNT ABDOMINAL TRAUMA
ASSESSMENT OF PENETRATING ABDOMINAL TRAUMA
IMAGING & INVESTIGATION OF PENETRATING ABDOMINAL INJURIES
GUNSHOT WOUNDS (GSWs)
INTERVENTIONAL THERAPY
ICU MANAGEMENT
DUODENAL INJURY
SMALL INTESTINAL INJURY
PANCREATIC INJURY
OTHER SPECIFIC INJURIES
References and links
Critical Care
Chris Nickson

Content: Abdominal Trauma: Blunt or penetrating • LITFL • CCC Trauma
Abdominal Trauma: Blunt or penetrating
Chris Nickson
Nov 3, 2020
Home CCC
Reviewed and revised 21 December 2015
OVERVIEW
Assessment of abdominal trauma requires the identification of immediately life-threatening injuries on primary survey, and delayed life threats on secondary survey. Primary survey
Resuscitation
Secondary survey
Diagnostic evaluation
Definitive care
Abdominal trauma is classified as blunt or penetrating, assessment and management is modified accordingly
BLUNT ABDOMINAL INJURY
Blunt abdominal injuries often managed conservatively, though interventional radiology and surgery are indicated for severe injuries
Common mechanisms include road traffic crashes, falls, sports injuries and assaults
organs most affected are : spleen > liver > small and large intestine
PENETRATING ABDOMINAL INJURY
Most patients with significant penetrating injury require laparotomy; there are differences in the management of projectiles (e.g. gunshot wounds) and non-projectiles (e.g. stabbings)
Any wound between the nipple line (T4) and the groin creases anteriorly, and from T4 to the curves of the iliac crests posteriorly is potentially a penetrating abdominal injury
If the wound was caused by a projectile, then a penetrating abdominal injury could result from an entry wound in almost any part of the body
These are the 4 regions of the abdomen to consider in penetrating injury: Anterior abdomen
— Between the anterior axillary lines; bound by the costal margin superiorly and the groin crease distally. Thoracoabdominal area
— The area superiorly delimited by the fourth intercostal space (anterior), sixth intercostal space (lateral), and eighth intercostal space (posterior), and inferiorly delimited by the costal margin (definitions vary — a pragmatic approach is to use the nipple line as the upper boundary… in non-obese men at least!). Injuries in the region increase the likelihood of chest, mediastinal, and diaphragmatic injuries.