Abdominal Trauma (Penetrating)


Background
  1. Caused by introduction of weapon or object into abdominal cavity
  2. Injury size is equivalent to abdominal viscera affected and proximity to entrance site
  3. Both intraperitoneal and extraperitoneal structures can be injured

Pathophysiology

  1. Anatomy
  2. Peritoneal injury can occur with lower chest / back wounds
  3. Each type of injury has distinct injury patterns

Diagnosis

  1. History
  2. Physical exam
  1. Diagnostic testing
  2. Diagnostic imaging
      • Positive if:
        • >10 cc gross blood, enteric contents
        • Bloody lavage effluent
        • >100,000 RBC/mm3 or >500 WBC/mm3
        • Amylase > 175 IU/dl
        • DPL fluid exits through CT or Foley catheters
        • Bacteria, vegetable fibers or food present

Potential Injuries

  1. Hepatic injury
  2. Diaphragmatic injury
  3. Vascular injury
  4. Splenic injury
  5. Pancreatic injury
  6. Kidney injury
  7. Intestinal injury

Treatment

  1. ATLS as usual
  2. DO NOT remove impaling objects
  3. FAST scan / DPL
  4. NG tube / foley PRN
  5. Rapid surgical evaluation and intervention
  6. Frequently reassess patient
  7. Prophylactic antibiotics
  8. Tetanus prophylaxis
  9. Local wound exploration

Disposition

  1. Almost all patients are admitted
  2. May possibly discharge if: