abdominal trauma l.m ntlhe department of surgery sbah-up

ABDOMINAL TRAUMAL.M NTLHE

Department of SurgerySBAH-UP

ABDOMINAL TRAUMA

Universal precautions against communicable diseasesPrinciples of initial assessment & resuscitation applyMay be on 2⁰ survey of your ABCs of resusc or 1⁰ survey & treatment of shock

0%

10%

20%

30%

40%

50%

60%

Minutes Hours Days

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

BAT

BAT

BAT

CLINICAL PRESENTATIONGENERAL-Stable or Unstable

-Coma or conscious & cooperative -PalePrimary survey done, now secondary survey

ABDOMINAL EXAMINATIONInspectionPalpationPercusionAuscaltationRectal 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, LaparascopyTREAT MENT : Resuscitation TREAT THE INJURED ORGAN

SOLID VISCERASpleen:

Liver:

Pancreatico-Duodenal:

Kidneys:

Spleen

Liver

HOLLOW VISCERAStomach:PenetratingBlunt (rare)Treatment: debride and suture (nonabsorbable sutures, two layers)Corrosive ingestion

Small Bowel:Penetrating – GSW -StabBlunt BlastTreatment: 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 ExaminationDuodenal haematoma→copious bilious vomitingAXRay-retroperitoneal air ( air nephrogram) -Scattered air bubbles -Obliterated psoas shadow -Free extra luminal air -Lumber & lower thoracic spineBlood- serum amylaseFASTCT

Pancreatico-Duodenal

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

Vascular injury- Vascular unitKidney-urology department