This document discusses the management of abdominal blunt trauma and damage control surgery. It begins by noting that abdominal blunt trauma is common, accounting for 22.7% of injuries, and that inappropriate management can lead to preventable deaths. It then covers classifications of abdominal trauma, common injury patterns, assessment techniques like FAST exam and DPL, and use of CT scan. The key points are that unstable patients require immediate surgical exploration while stable patients can be further evaluated. Damage control surgery aims to rapidly control bleeding and contamination to stabilize the patient for further care.

1. Anne Saputra aputraAANAN
ABDOMINAL BLUNT TRAUMA
AND
DAMAGE CONTROL SURGERY

2. INTRODUCTION
• Blunt abdominal trauma is common
• Incidence 22,7%(RISKESDAS, 2013)
• Half of preventable trauma death are related to inappropriate
management of abdominal trauma
• Victims frequently have both abdominal and extraabdominal
injuries.
• Able to recognize and treat hemorrhagic shock.
RISKESDAS 2013, Badan Penelitian dan Pengembangan Kesehatan kementrian Republik Indonesia

3. CLASSIFICATION
Abdominal Trauma
 Penetrating
High velocity (85% penetrate peritoneum)
Low velocity (95% need surgery)
Stab (1/3 do not penetrate the peritoneum, of those 50% need Surgery)
 Blunt trauma
High energy transfer (car accident)
Low energy transfer (fall, fight)
Mattox 2013, in Trauma 7th ed

4. ACS 2012, Advanced Trauma Life Support 9th ed.
 Spleen 40-55%
 Liver 35-45%
 Hollow viscus 15%
 Ileum
 Sigmoid
 Kidney 12%
 Retroperitoneal 13%
 Mesentery 5%

5. ALOGARITM
Mattox, Moore and Feliciano 2013, Trauma 7th ed

7. Assessment and Initial InvestigationAssessment and Initial Investigation
Test of choice dependent on hemodynamic stability and
severity of associated injuries.
Stable blunt trauma →FAST or CT
Unstable blunt trauma →FAST or DPL
Stab wounds without peritoneal signs, evisceration, or
hypotension →wound exploration or DPL.
Gun shot wounds →surgical exploration.
Bailey and Love’s 2008, Short Practice of Surgery 25th ed

8.  a decision-making tool to help determine the need for
transfer to the operating room, CT scanner or
angiography suite.
 Sensitivity of 92%,
 Specifisity of 96%
 FAST examines four areas for free fluid:
◦ Morrison’s Pouch
◦ Perisplenic
◦ Pelvis
◦ +/-Pericardium
FAST: Focused Assessment withFAST: Focused Assessment with
Sonography in TraumaSonography in Trauma

9. Morrison’s PouchMorrison’s Pouch
 probe is placed in the right mid- to posterior axillary
line at the level of the 11th and 12th ribs

10. PerisplenicPerisplenic
 transducer is placed on
the left posterior
axillary line region
between the 10th and
11th ribs.

11. PelvicPelvic
 transducer is placed
midline just superior to
the symphysis pubis.

12. PericardialPericardial
 transducer is placed
just to the left of the
xiphisternum and
angled upwards under
the costal margin

13.  Pros
◦ Noninvasive
◦ Fast
◦ Low cost
 Cons
◦ User dependent
◦ Obesity, gas interposition
◦ Misses retroperitoneal/hollow viscus injury
◦ May not detect free fluid <50-80 cc
FASTFAST

14.  Standard criteria
◦ 10cc gross blood
◦ RBC>100,000/mm2 (5% miss)
◦ WBC>500/mm2
◦ Amylase>175 IU/dL
◦ Bile, bacteria, or food
 Contraindications
◦ Clear indication for ex lap
◦ Prior abdominal surgeries
◦ Pregnancy
◦ Obesity
DPLDPL
*NGT, foley

15.  Highly sensitive to intraperitoneal blood, but low
specificity →nontherapeutic explorations.
 Significant injuries may be missed
◦ Diaphragm
◦ Retroperitoneal hematomas
◦ Renal, pancreatic, duodenal
◦ Minor intestinal
◦ Extraperitoneal bladder injuries
 DPL fast, sensitive, accurate, simple
DPLDPL

16.  Hemodynamically stable patient
 Pros
◦ Retroperitoneal assessment
◦ Nonoperative management of solid organ injury
◦ High specificity
 Cons
◦ Hardware, cost, radiation
◦ Hollow viscus injuries, diaphragm injury
CT ScanCT Scan

17. ACS 2012, Advanced Trauma Life Support 9th ed.

18. DAMAGE CONTROL
• Damage limitation surgery
• Goal -> 1. STOP any active surgical bleeding
• 2. Control contamination
Bailey and Love’s 2008, Short Practice of Surgery 25th ed

19. Jacobs 2010, Advanced Trauma Operative Management 2nd ed

20. Bailey and Love’s 2008, Short Practice of Surgery 25th ed

23. Thank You