ABDOMINAL TRAUMA L.M NTLHE Department of Surgery SBAH-UP

ABDOMINAL TRAUMA Universal precautions against communicable diseases Principles of initial assessment & resuscitation apply May be on 2⁰ survey of your ABCs of resusc or 1⁰ survey & treatment of shock

1.Penetrating: stab wound gunshot wound 2. Blunt- MVA/blunt assault/fall from heights 3. Blast Mechanism of Injury

PENETRATING ABDO TRAUMA

BLUNT ABDOMINAL TRAUMA (BAT) SCENARIO

DEFINITION INJURIES TO MORE THAN ONE ANATOMICAL AREA INCIDENCE – 10-15% OF TRAUMA PATIENTS

BAT

CLINICAL PRESENTATION GENERAL-Stable or Unstable -Coma or conscious & cooperative -Pale Primary survey done, now secondary survey

ABDOMINAL EXAMINATION Inspection Palpation Percusion Auscaltation Rectal examination

Local-open wound± -bruising -Distension -Tender (peritonitic) -B/S ± absent -PR - ±blood

MANAGEMENT – INVESTIGATIONS: Blood – U + E/FBC Radiology – CXRay/AbdXRay -U/S (FAST), CT Scan, DPL, Laparascopy TREAT MENT : Resuscitation TREAT THE INJURED ORGAN

SOLID VISCERA Spleen: Liver: Pancreatico-Duodenal: Kidneys:

Spleen

Liver

HOLLOW VISCERA Stomach: Penetrating Blunt (rare) Treatment: debride and suture (nonabsorbable sutures, two layers) Corrosive ingestion

Small Bowel: Penetrating – GSW -Stab Blunt Blast Treatment: debride and suture

Duodenal and Pancreatic injuries: 3-5 % Penetrating 75%-GSW 85% Blunt-crushing against vertebral column -shearing forces -duodenal blow out

DIAGNOSIS : History and Examination Duodenal haematoma→copious bilious vomiting AXRay-retroperitoneal air ( air nephrogram) -Scattered air bubbles -Obliterated psoas shadow -Free extra luminal air -Lumber & lower thoracic spine Blood- serum amylase FAST CT

Pancreatico-Duodenal

Treatment – Pancreas: hemorrhage→haemostasis – Major duct :→distal pancreatectomy – Proximal→Whipple procedure(↑mortality) Colon →1⁰ repair Rectum/Anus: Diverting colostomy

Vascular injury- Vascular unit Kidney-urology department