62 - Abdominal trauma

Summary

In patients with blunt abdominal trauma, emergent or urgent laparotomy is performed for hypotension and abdominal hemorrhage (frequently confirmed by diagnostic peritoneal lavage or surgeon-performed ultrasound), overt peritonitis, or obvious signs of abdominal visceral injury without the need for further advanced diagnostic studies. Included are patients with significant proctorrhagia after pelvic fracture; those with evidence of a ruptured hemidiaphragm or air in the peritoneal cavity or retroperitoneum on plain radiographs; and those with evidence of a ruptured duodenum, intraperitoneal rupture of the bladder, or significant injury to the renal artery or kidney on contrast-enhanced radiographs. All other stable patients whose abdominal examinations are compromised by an abnormal sensorium (related to alcohol, drugs, head injury), abnormal sensation (due to spinal cord injury), or adjacent injuries are best evaluated by abdominal helical computed tomography.

In patients with stab wounds to the abdomen, emergent or urgent laparotomy is performed for abdominal distention and hypotension, overt peritonitis, significant evisceration, or obvious signs of abdominal visceral injury without the need for further advanced diagnostic studies. Included in the last group are patients with hematemesis, proctorrhagia, or hematuria; those with evidence of diaphragmatic defect on finger palpation before insertion of a thoracostomy tube; and those with evidence of an injury to the kidney, ureter, or bladder on contrast-enhanced radiograph. All other stable and reasonably cooperative patients undergo local exploration of the stab wound to verify peritoneal penetration. In asymptomatic patients with peritoneal penetration, a 24-hour period of observation is appropriate.