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Abdominal Trauma: Causes, Symptoms & Treatment

Abdominal trauma is an injury to the abdomen caused by external force. It can damage internal organs, blood vessels, and tissues, often requiring immediate medical attention.

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Things worth knowing about "Abdominal Trauma"

Abdominal trauma is an injury to the abdomen caused by external force. It can damage internal organs, blood vessels, and tissues, often requiring immediate medical attention.

What is Abdominal Trauma?

Abdominal trauma refers to an injury of the abdominal cavity resulting from external force. It can affect organs such as the liver, spleen, kidneys, intestines, stomach, or major blood vessels. Depending on the type and severity of the injury, abdominal trauma can be life-threatening and constitute a medical emergency.

Causes

Abdominal trauma results from various injury mechanisms:

Blunt abdominal trauma: Injury without penetration of the abdominal wall, typically caused by road traffic accidents, falls, blows, or sports injuries. This is the most common form.
Penetrating abdominal trauma: Injury involving an object entering the abdominal cavity, such as stab or gunshot wounds.
Deceleration trauma: Sudden deceleration (e.g., in motor vehicle accidents) that can cause tears in organs and blood vessels.

Symptoms

Symptoms of abdominal trauma can vary depending on severity and the structures involved:

Severe abdominal pain or tenderness on palpation
Rigidity of the abdominal wall (so-called guarding or abdominal rigidity)
Visible injuries or bruising on the abdomen
Nausea and vomiting
Signs of shock: pale skin, rapid pulse, drop in blood pressure, altered consciousness
Blood in the urine (indicating possible kidney injury)
Abdominal distension due to internal bleeding or accumulation of gas

Diagnosis

Diagnosis of abdominal trauma is based on a combination of clinical examination and imaging techniques:

Physical examination: Palpation of the abdomen for tenderness, rigidity, and signs of injury.
Ultrasound (FAST exam): A rapid bedside method to detect free fluid (blood) in the abdominal cavity; commonly used as FAST (Focused Assessment with Sonography in Trauma).
Computed tomography (CT scan): Detailed imaging to accurately assess organ injuries and bleeding.
Laboratory tests: Full blood count, coagulation parameters, liver enzymes, and kidney function tests to assess the extent of injury.
Diagnostic peritoneal lavage: Flushing of the abdominal cavity to detect blood or bowel contents; less commonly used today.

Treatment

Treatment depends on the type and severity of the abdominal trauma:

Conservative Management

Minor injuries, such as small lacerations of the spleen or liver without active bleeding, may be managed conservatively under close inpatient monitoring. This includes bed rest, pain management, and regular follow-up examinations.

Surgical Treatment

Severe injuries, uncontrollable bleeding, or injuries to hollow organs (e.g., bowel perforation) require immediate surgery. The goals are to achieve hemostasis, repair organ injuries, and decontaminate the abdominal cavity (laparotomy). In selected cases, minimally invasive approaches (laparoscopy) may be used.

Interventional Radiology

In cases of arterial bleeding, embolization (blocking the bleeding vessel) performed by an interventional radiologist may offer a less invasive alternative to surgery.

Intensive Care

Severe abdominal trauma often requires treatment in an intensive care unit, including circulatory stabilization, blood transfusions, and monitoring of organ functions.

Complications

Potential complications of abdominal trauma include:

Internal bleeding with hemorrhagic shock
Peritonitis (inflammation of the abdominal lining) due to leakage of bowel contents
Organ failure (e.g., kidney failure, liver failure)
Infections and abscess formation within the abdominal cavity
Delayed splenic rupture (a tear in the spleen that develops days after the initial injury)

References

Deutsche Gesellschaft fur Unfallchirurgie (DGU): S3 Guideline on Polytrauma and Severely Injured Patient Management, AWMF Register No. 187-023, 2022.
Tintinalli JE et al.: Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 9th Edition, McGraw-Hill Education, 2020.
World Health Organization (WHO): Injuries and Violence - The Facts, WHO Press, Geneva, 2014.

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