Abdominal trauma accounts for 15% to 20% of
all trauma deaths.1 These deaths primarily occur
soon after injury as a result of hemorrhage, although some occur
later due to complications from sepsis.
Injuries to the abdomen can be from blunt or penetrating mechanisms, or,
The most common mechanism of blunt abdominal trauma in the U.S.
is a motor vehicle crash.1 This diffuse injury
pattern puts all abdominal organs at risk for injury. The biomechanics
of blunt trauma to the abdomen involve compressive, shearing, or
stretching forces. The outcome may be injury to solid organs (e.g.,
liver or spleen) or hollow viscera (e.g., the GI tract).
Injury can also result from the movement of organs within the
body. Some organs are rigidly fixed, whereas others are more mobile.
Injury is particularly common in areas of transition between fixed
and mobile organs. Examples at areas of transition include mesenteric
or small bowel injuries, primarily at the ligament of Treitz or
at the junction of the distal small bowel and right colon.
Falls from a height produce a unique pattern of injury. Injury
severity is a function of distance, the surface on which the victim
lands, and whether the fall is broken. Intra-abdominal injuries
are rare in falls from a height. When abdominal injuries do occur,
hollow visceral rupture is the most common injury.2 Retroperitoneal
injuries occur frequently due to force transmitted up the axial
skeleton and are associated with severe retroperitoneal hemorrhage.
Intra-abdominal solid organs can be injured when patients land on
Pedestrians struck by motor vehicles are completely unprotected,
and all force is applied directly to the patient’s body.
Motorcyclists and bicyclists are generally protected only by a helmet.
Stab wounds directly injure tissue as the blade passes through
the body. External examination of the wound may underestimate internal
damage and cannot define the trajectory. Assume that any stab
wound in the lower chest, pelvis, flank, or back causes abdominal
injury until proven otherwise.
Gunshot wounds injure in several ways. Bullets may injure organs
directly, by secondary missiles such as bone or bullet fragments,
or from energy transmitted from the bullet (blast effect). Bullets
designed to break apart once they enter a victim cause much more
tissue destruction than ones that remain intact. Entrance and exit
wounds can approximate the trajectory. Localization of the foreign
body helps predict organs at risk. Bullets, however, may not travel
in a straight line. Thus, all structures in any proximity to the
presumed trajectory must be considered injured (see Chapter e263.1, Wound Ballistics).
Abdominal injury often presents insidiously. Young patients may
lose 50% to 60% of their blood volume and remain
asymptomatic.3 In addition, trauma to the abdomen
may be accompanied by neurologic alterations from ...