1. Dr Aleksandar Radevic, Dr Goran Milicevic,Dr Aleksandar Radevic, Dr Goran Milicevic,
ABDOMINAL TRAUMAABDOMINAL TRAUMA
TRAUMATIC INJURIES OFTRAUMATIC INJURIES OF
ABDOMINAL PARENCHYMALABDOMINAL PARENCHYMAL
ORGANS-LIVER, SPLEENORGANS-LIVER, SPLEEN
AND KIDNEYSAND KIDNEYS
-DIAGNOSTIC APPROACH--DIAGNOSTIC APPROACH-
2. Disproportionately striking theDisproportionately striking the
young and male population,traumayoung and male population,trauma
is responsible for the loss of moreis responsible for the loss of more
productive years of life than cancerproductive years of life than cancer
and cardiovascular diseasesand cardiovascular diseases
combined.combined.
3. Trauma most often results fromTrauma most often results from
traffic accidents, free or accidentaltraffic accidents, free or accidental
falls from a height and violence.falls from a height and violence.
In multiple traumatized patientsIn multiple traumatized patients
abdominal injuries occur in 20 toabdominal injuries occur in 20 to
45% and are responsible for a45% and are responsible for a
similar rate of death in the earlysimilar rate of death in the early
hours after trauma as severe head.hours after trauma as severe head.
4. Morbidity and lethality of abdominalMorbidity and lethality of abdominal
trauma is highly dependent ontrauma is highly dependent on
timly therapeutic intervention.Ontimly therapeutic intervention.On
the other hand, abdominal injuriesthe other hand, abdominal injuries
are often missed inare often missed in
multitraumatized patients.multitraumatized patients.
5. The introduction of ultrasound andThe introduction of ultrasound and
computed tomography (CT, MDCT)computed tomography (CT, MDCT)
and there application has improvedand there application has improved
the diagnostic approach tothe diagnostic approach to
multitraumatized patients andmultitraumatized patients and
therapy as soon as possible.therapy as soon as possible.
6. Ultrasound has been accepted as the first step inUltrasound has been accepted as the first step in
radiological assessment. Ultrasound is of particularradiological assessment. Ultrasound is of particular
value in deciding whether immediate surgicalvalue in deciding whether immediate surgical
exploration in hemodynamically stable patients- freeexploration in hemodynamically stable patients- free
intra-abdominal fluid.intra-abdominal fluid.
7. In the hemodynamically patients moreIn the hemodynamically patients more
sophisticated assessment of the injuriessophisticated assessment of the injuries
can be achived by CT and MDCT.can be achived by CT and MDCT.
8. Patients with abdominal traumaPatients with abdominal trauma
most often have injuries ofmost often have injuries of
parenchymal organs-liver, spleenparenchymal organs-liver, spleen
and kidneys.and kidneys.
9. LIVER TRAUMALIVER TRAUMA
Traumatic liver injuries are mostTraumatic liver injuries are most
often caused by blunt traumas oroften caused by blunt traumas or
injuries of right hemithoracs.injuries of right hemithoracs.
10. SURGICAL LIVER INJURY GRADINGSURGICAL LIVER INJURY GRADING
SCALESCALE
I HEMATOMA (subcapsular, <10% of surface)I HEMATOMA (subcapsular, <10% of surface)
LACERATION (capsular,<1cm in parenchymal depth)LACERATION (capsular,<1cm in parenchymal depth)
11. II HEMATOMA (subcapsular 10-50% of surface,II HEMATOMA (subcapsular 10-50% of surface,
parenchymal,<10cm in diameter )parenchymal,<10cm in diameter )
LACERATION (parenchymal, 1-3cm in parenchymalLACERATION (parenchymal, 1-3cm in parenchymal
depth, <10cm in lenght)depth, <10cm in lenght)
12. III HEMATOMA (subcapsular, >50% of surface orIII HEMATOMA (subcapsular, >50% of surface or
expanding ruptured hematoma)expanding ruptured hematoma)
LACERATION (intraparenchymal, >10cm or expandingLACERATION (intraparenchymal, >10cm or expanding
>3cm in depth)>3cm in depth)
13. IV LACERATION (25-75% of hepatic lobe or 1-3 segmentsIV LACERATION (25-75% of hepatic lobe or 1-3 segments
within lobe)within lobe)
14. V LACERATION (>75% of lobe or >3 segments withinV LACERATION (>75% of lobe or >3 segments within
lobe)lobe)
VASCULAR (Juxtahepatic major hepatic vein or VCIVASCULAR (Juxtahepatic major hepatic vein or VCI
injury)injury)
16. SPLEEN TRAUMASPLEEN TRAUMA
Traumatic spleen injuries are causedTraumatic spleen injuries are caused
bbyy blunt traumasblunt traumas. 40% of abdominal. 40% of abdominal
organs traumas are spleen injuries.organs traumas are spleen injuries.
Spleen injuries are often accompaniedSpleen injuries are often accompanied
with left thoracs ribs fractures.with left thoracs ribs fractures.
17. SURGICAL SPLENIC INJURY SCALESURGICAL SPLENIC INJURY SCALE
I HEMATOMA (subcapsular, <10% of surface)I HEMATOMA (subcapsular, <10% of surface)
LACERATION (capsular,<1cm in parenchymal depth)LACERATION (capsular,<1cm in parenchymal depth)
18. II HEMATOMAII HEMATOMA (subcapsular, 10-50% of surface;(subcapsular, 10-50% of surface;
parenchymal <5cm in diameter)parenchymal <5cm in diameter)
LACERATION (parenchymal, 1-3cm in depth, trabecularLACERATION (parenchymal, 1-3cm in depth, trabecular
vessels not involved)vessels not involved)
19. III HEMATOMA (III HEMATOMA (susubcapsularbcapsular,, >50% of surface or>50% of surface or
expanding ruptured hematoma;parenchymal, >5cm inexpanding ruptured hematoma;parenchymal, >5cm in
diameter or expanding)diameter or expanding)
LACERATION (parenCHYMAL, >3cm in depth or involvingLACERATION (parenCHYMAL, >3cm in depth or involving
trabecular vessels)trabecular vessels)
20. IV LACERATION (segmental or hilar vessels involved inIV LACERATION (segmental or hilar vessels involved in
devascularisation->25% of spleen)devascularisation->25% of spleen)
21. V LACERATION (shattered spleen)V LACERATION (shattered spleen)
VASCULAR (hilar injury with devascularized spleen)VASCULAR (hilar injury with devascularized spleen)
22. KIDNEY TRAUMAKIDNEY TRAUMA
Traumatic kidney injuries are oftenTraumatic kidney injuries are often
caused by blunt traumas, stab andcaused by blunt traumas, stab and
penetrating wounds in the abdomen.penetrating wounds in the abdomen.
23. SURGICAL RENAL INJURY SCALESURGICAL RENAL INJURY SCALE
II CONTUSION (hematuria with normal urological studies)CONTUSION (hematuria with normal urological studies)
HEMATOMA (subcapsular,nonexpanding)HEMATOMA (subcapsular,nonexpanding)
24. II HEMATOMA (perirenal, nonexpanding)II HEMATOMA (perirenal, nonexpanding)
LACERATION (parenchymal,<1cm, without urinaryLACERATION (parenchymal,<1cm, without urinary
extravasation)extravasation)
25. III LACERATION (parenchymal, >1cm, without urinaryIII LACERATION (parenchymal, >1cm, without urinary
extravasation)extravasation)
26. IV LACERATION (extending trough cortex, medulla andIV LACERATION (extending trough cortex, medulla and
collecting system)collecting system)
VASCULAR (main renal artery or vein injury withVASCULAR (main renal artery or vein injury with
contained hemorhhage)contained hemorhhage)
27. V LACERATION (shattered kidney)V LACERATION (shattered kidney)
VASCULAR (hilar avulsion with devascularized kidney)VASCULAR (hilar avulsion with devascularized kidney)
