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Abdominal trauma
The document discusses the assessment and management of abdominal trauma, including classifications, investigations like FAST and CT scans, and management strategies for various types of injuries. It emphasizes the importance of timely surgical intervention, particularly in unstable patients, and notes that diagnostic peritoneal lavage (DPL) has largely been replaced by FAST. The document also outlines specific management protocols for both blunt and penetrating abdominal trauma, recognizing the complexity of such injuries.
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Abdominal trauma
- 1. Abdominal Trauma Chea ChanHooi Surgeon Sibu Hospital BLS Sibu Hospital 14/08/2018
- 2. Content • Anatomy • Classification •Investigations • Management • Conclusion • Q&A
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- 4. Classification • Etiology – Blunt –Penetrating • Structure injured – Abdominal wall – Solid organ (liver, spleen, kidneys) – Hollow organ (GI tract, ureters, bladder) – Vasculature
- 5. Blunt abdominal trauma •Examination findings – Distension – Seat belt sign – Ecchymoses of flanks (Grey Turner) or umbilicus (Cullen) – Tender, guarded – Absent bowel sounds – Lower chest injuries
- 6. Investigations • FAST – FocusedAssessment with Sonography in Trauma – Standard examination tool – Four windows – pelvic, perihepatic, perisplenic, pericardial – Benefits • Easily & rapidly available • Allows repeated exams • No radiation • Non invasive
- 7. • CT scan –All stable blunt abdominal trauma patients with suspected intra-abdominal injuries – Responders or transient fluid responders – Detects and identifies injuries to solid or hollow organs and also source of haemorrhage – Active haemorrhage necessitates laparotomy
- 8. • DPL – Diagnosticperitoneal lavage – Open or percutaneous technique – Indications • Unreliable physical exam (spinal cord injury, altered mental state, intubated) • FAST or CT not available • Radiographs equivocal – Obsolete
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- 11. Management • Exploratory laparotomy –Liver injury • Packing • Second look laparotomy in 48 – 72 hours – Splenic injury • Splenectomy • Splenorrhapy – Mesenteric injury • Haemostasis • Bowel resection if ischaemic – Pancreatic injury • Washout and peritoneal drainage • Delayed repair or pancreatectomy – Bladder injury • Repair – Renal injury • Non-operative management in the vast majority • Nephrectomy – Great vesselinjury • Repair or ligation
- 12. • Non-operative management –Admit – CRIB – Close vital sign monitoring – Analgesics – GXM 4 units packed cells – Daily monitoring of Hb, TWC & Urea/Creat – Indication for laparotomy • Haemodynamic unstable • Peritonism • Persistent blood product transfusion
- 13. Penetrating abdominal trauma •Beware of entry wound from lower chest, flanks, back • Breach the parietal peritoneum • Gunshots a/w higher energy destruction,almost always need laparotomy • Examination – Evisceration – Location of wound(s) – Nature of effluent from wound – Blood from NG tube or anus
- 14. Examination • Local woundexploration – Under LA – Wound extended and tract identified along its length • If anterior fascia intact – T&S and no further surgical intervention • If anterior fascia breached – FAST or CT scan positive – laparotomy – FAST or CT scan negative » Admit for observation » Surgical intervention if develop peritonitis or haemodynamics deteriorate
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- 16. Parietal peritoneal breachon screening laparoscopy
- 17. Intra-abdominal injuries • Allsolid or hollow organ injuries intra- operatively managed similar to blunt injury
- 18. Conclusion • Abdominal traumacan be associated with polysystemic trauma • Patients tend to be unstable and may require crash laparotomy • DPL has been replaced by FAST • CT scan is helpful but must not delay surgical intervention in unstable patients • Unnecessary laparotomy can be avoided in well- selected patients with penetrating abdominal trauma
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- 20. 2nd Sibu Update onSurgical Emergencies (SUSE 2019)