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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, occasionally, both.

Blunt Abdominal Trauma

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 the flank.

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.

Penetrating Abdominal Trauma

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 ...

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