Abdominal trauma
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Lecture on abdominal trauma during Basic Life Support 2018 course in Sibu Hospital. Encompasses blunt and penetrating trauma, principles and tips of management
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Abdominal trauma
- 1. Abdominal Trauma Chea Chan Hooi Surgeon Sibu Hospital BLS Sibu Hospital 14/08/2018
- 2. Content • Anatomy • Classification • Investigations • Management • Conclusion • Q&A
- 3. Anatomy
- 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 – Focused Assessment 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 – Diagnostic peritoneal lavage – Open or percutaneous technique – Indications • Unreliable physical exam (spinal cord injury, altered mental state, intubated) • FAST or CT not available • Radiographs equivocal – Obsolete
- 9. Positive DPL
- 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 wound exploration – 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
- 15. Management
- 16. Parietal peritoneal breach on screening laparoscopy
- 17. Intra-abdominal injuries • All solid or hollow organ injuries intra- operatively managed similar to blunt injury
- 18. Conclusion • Abdominal trauma can 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
- 19. Thank you! Q&A?
- 20. 2nd Sibu Update on Surgical Emergencies (SUSE 2019)