Blunt Abdomen Trauma

Neneng halimatusa’diah

Perseptor
Liza nursanty.,dr.,Sp.B
ABDOMINAL REGION
Abdominal quadrant
 Blunt Abdominal Trauma

• Greater mortality than PAT (more difficult to diagnose, commonly

associated with trauma to multiple organs/systems)
• Most commonly injured organs: spleen > liver, intestine is the most
likely hollow viscus.
• Most common causes: MVA (50 - 75% of cases) > blows to abdomen (15%)
> falls (6 - 9%)
Etiology

 Motor vehicle accidents

 Fall from heights
 Compression
 Deceleration
 Physical assault
Patofisiologi

• Rupture or burst injury of a hollow organ by sudden rises in intra-

abdominal pressures
• Crushing effect
• Acceleration and deceleration forces → shear injury
• Seat belt injuries
• “seat belt sign” = highly correlated with intraperitoneal injury
Signs and symptoms

• Abdominal pain • Abdominal distension

• Tendernes • Anemia
• Gastrointestinal hemorrhage • Lap belt marks
• Nausea & vomiting • Ecchymosis involving the flanks
• Kehr’s sign • Abdominal bruit
• Local or generalized tendernes,
• Hypovolemia
guarding, rigidity, or rebound
• Loss of consciousness tenderness
• Peritonitis
Diagnosis

HISTORY
Laboratory
• Blunt abdominal trauma • blood tests
• Penetrating abdominal trauma • Urinalysis

PHYSICAL EXAMINATION Radiological Studies (Plain abdominal

X-ray, CXR)
• General physical examination Peritoneal lavage (DPL)
• Examination of the abdomen FAST U/S of abdomen
CT scan of abdomen
Examination of the abdomen

• Look for signs of intraperitoneal injury

• abdominal tenderness, peritoneal irritation, gastrointestinal
hemorrhage, hypovolemia, hypotension
• entrance and exit wounds to determine path of injury.
• Distention - pneumoperitoneum, gastric dilation, or ileus
• Ecchymosis of flanks (Gray-Turner sign) or umbilicus (Cullen's sign) -
retroperitoneal hemorrhage
• Abdominal contusions – eg lap belts
• ↓bowel sounds suggests intraperitoneal injuries
• DRE: blood or subcutaneous emphysema
 FAST

• Focused assessment with sonography for trauma (FAST)

• To diagnose free intraperitoneal blood after blunt trauma
• 4 areas:
• Perihepatic & hepato-renal space (Morrison’s pouch)
• Perisplenic
• Pelvis (Pouch of Douglas/rectovesical pouch)
• Pericardium (subxiphoid)
• sensitivity 60 to 95% for detecting 100 mL - 500 mL of fluid
• Extended FAST (E-FAST):
• Add thoracic windows to look for pneumothorax.
• Sensitivity 59%, specificity up to 99%
FAST
• Morrison’s pouch (hepato-renal space)
 FAST

• Perisplenic view
FAST
• Retrovesicle (Pouch of Douglas)

• Pericardium (subxiphoid)
 FAST
• Advantages:
• Portable, fast (<5 min),
• No radiation or contrast
• Less expensive
• Disadvantages
• Not as good for solid parenchymal damage,
retroperitoneum, or diaphragmatic defects.
• Limited by obesity, substantial bowel gas, and subcut
air.
• Can’t distinguish blood from ascites.
• high (31%) false-negative rate in detecting
hemoperitoneum in the presence of pelvic fracture
Diagnostic Peritoneal Lavage

• Largely replaced by FAST and CT

• In blunt trauma, used to triage pt who is HD unstable and
has multiple injuries with an equivocal FAST examination
• In stab wounds, for immediate dx of hemoperitoneum,
determination of intraperitoneal organ injury, and
detection of isolated diaphragm injury
• In GSW, not used much
Diagnostic Peritoneal Lavage

• 1. attempt to aspirate free peritoneal blood

• >10 mL positive for intraperitoneal injury
• 2. insert lavage catheter by seldinger, semiopen, or open
• 3. lavage peritoneal cavity with saline
• Positive test:
• In blunt trauma, or stab wound to anterior, flank, or back: RBC
count > 100,000/mm3
• In lower chest stab wounds or GSW: RBC count > 5,000-
10,000/mm3
Treatment

• Airway, Breathing, Circulation

• History of injury and mechanism
• Physical examination and vital signs
• Radiologic studies
• Laboratory testing
Resuscitation & management priorities of major
abdominal trauma:

• Control airway and breathing

• Stabilize circulation with volume
infusion or blood
• Hemorrhage control
• Nasogastric tube and urinary catheter if
no pelvic fracture
INDICATIONS FOR EMERGENT SURGERY

• Peritonitis
• Hypotensive shock
• Evisceration of viscus
• Positive diagnostic (DPL)
• Determination of finding on FAST or CAT scan
Terimakasih