Medical

1. Abdominal Trauma
Name : Mohan Bhopale
Sem : 10th
Group : 7

2. DEFINITION AND INTRODUCTION
• TRAUMA – cellular disruption caused by
environmental energy / physical force
• 6thleading cause of death worldwide(10% of
cases)
• Leading cause of death in those aged 5 to 40
years
• Majority of trauma cases is due to road traffic
accidents (70.1%)

3. Assessment and resuscitation
• Primary survey with concurrent resuscitation.
• Requires a team of doctors, nurses, assistant
medical doctors and attendants.
• Must be lead by a team leader.
• Secondary survey with concurrent resuscitation.
• Reassessment and on going resuscitation while
reviewing investigations.

4. ABDOMINAL TRAUMA

5. MECHANISM OF INJURY
Blunt trauma Penetrating injury
Fall from height Stab wound
MVA Gunshot wound
Domestic injury
Sport injury
Contact injury
Child abuse

6. Abdominal injuries
• Intraperitoneal
• Solid, hollow, mesentery
• Retroperitoneal
• Abdominal wall (hematoma) esp in warfarinized
or hemophilia patients after minor trauma.

7. Intraperitoneal
• Solid organs
▫ Spleen(40-55%)
▫ Liver(35-45%)
• Hollow organs
▫ Gastric, bowel, bladder or GB perforation
▫ Penetrating injury
• Mesentery (bowel ischaemia)

8. Retroperitoneal
• Pancreas (10-20%) – traumatic pancreatitis
• Vascular(5-10%) – major vessels
• Kidneys(5%)

9. Indications for laparotomy
• Blunt abdominal trauma + hypotension +
positive FAST or clinical evidence of
intraperitoneal bleeding
• Penetrating trauma : eg : Gunshot or abdominal
evisceration
• Peritonitis
• Free air, retroperitoneal air or rupture of
hemidiaphragm after blunt trauma
• Organ specific injury - on CT scan

10. Splenic injury
• 20% due to left lower rib fractures
Conservative Management:
▫ Hemodynamic stable
▫ Negative abdominal examination
▫ Absence of contrast extravasation in CT
▫ Subcapsular Hematoma, Laceration <3cm
• Serial abdominal examination and CT scan.
• Success rate of conservative Mx >80%

12. Operative management
• Splenorrhaphy with serial monitoring.
• Total Splenectomy and vaccination.
• Success rate of splenic salvage procedure is 40-
60%.
• Others – partial splenectomy, total splenectomy
with autotransplantation.

13. Liver injury
• Largest organ - 2ndmost commonly injured
• 85% with blunt hepatic trauma are stable
• CT – main stay of diagnosis in stable patient
• Most treated conservatively
• Watch out for on going bleed, hepatic necrosis,
infected billoma, biliary tree injuries.

15. Conservative management
• Haemodynamically stable
• No other intra abdominal injury require surgery
• < 2 units of blood transfusion required in 6
hours
• Hemoperitoneum <500ml on CT

16. Operative management
• Liver packing
- Bleeding can be stopped
- Pack removed after 48hr
• Pringle’s maneuver
-Direct compression of the portal triad
(digitally or soft clamp) to control the inflow
• Lobar Resection
• Liver Transplantation

17. Renal injury
• Clinically not suspected & frequently overlooked
• Clinical - Shock, hematuria & pain over the loin
• Urine: gross or microscopic hematuria
• CT scan – Grading

18. Treatment
• 85% of blunt renal trauma can be manage
conservatively.
• Indications for nephrectomy
▫ Hemodynamic instability
▫ Grade 5 renal injury
• Risk of dialysis should be explained if planned for
nephrectomy.

19. Take home messages
• Primary survey and resuscitation goes hand in
hand. It’s an ongoing process.
• Coagulopathy, hypothermia, and worsening
metabolic acidosis are lethat triad that need to
be watched out for in trauma patients
• Fluid resuscitation is vital and evaluation of it is
important.
• Negative FAST scan cannot exclude possibility of
significant intraabdominal injury if clinically is
indicated.

20. • CT scan is
intraabdominal
stable patient.
gold standard to diagnose
injury in hemodynamically
• 20% of splenic injury is due to lower rib
fractures
• 85% with blunt hepatic trauma are stable
• 85% of blunt renal trauma can be manage
conservatively

21. •Thank you!