December 28, 2011 | Abdominal Trauma
Physical trauma is a serious injury caused by a sudden energy transfer of an external force (i.e. motor vehicle crashes) to a person’s body. Abdominal trauma involves the abdominal area wherein most internal organs are involved. The most common type of intra-abdominal organ injury is hepatic injury.1HOW IT IS SUSTAINED
Like cardiac trauma, abdominal trauma can either be blunt or penetrating.
- Blunt abdominal trauma – Intra-abdominal injuries due to dull or blunt force are due to collisions between the injured individual and the external environment and to acceleration or deceleration forces targeting the individual’s internal organs. Blunt force injuries to the abdomen can generally be explained by 3 mechanisms.3
- Deceleration. Brisk deceleration results in varying movements among adjacent structures inside the abdomen. Subsequently, shear forces are made and will result in hollow, solid, visceral organs and its nearby blood vessels to be injured.
- Crushing. Intra-abdominal contents are crushed between the walls of the abdomen (skin and muscles) and the skeletal structures. A crushing effect will be produced, to which solid organs are at risk. A crushing injury is common in car accidents, truck accidents, and motorcycle accidents.
- External compression. Direct blows or from external compression against a fixed object can also cause abdominal trauma. External forces result in a rapid and remarkable increase in intra-abdominal pressure and this will result to rupture of intra-abdominal contents.
Most motor vehicle traumas are caused by motor vehicle accidents, with one-third of them associated with alcohol intake.
- Penetrating abdominal trauma – Sharp or pointed objects (i.e. broken glass, vehicle parts) during a motor vehicle accident can penetrate the abdomen if the impact is extremely strong. The small intestine is the most common organ affected by penetrating abdominal trauma due to its large surface area.4
SYMPTOMSPain in the abdominal area is the most common symptom. Hypotension might also be present. A large hematoma on the abdomen may also indicate bleeding inside the abdominal cavity. Physical examination findings in blunt abdominal trauma are usually unreliable because this type of trauma usually involves multiple organ injuries. Laboratory and radiographic studies are required for diagnosis. 2
The external appearance or the skin of a penetrating abdominal trauma does not conclude the area affected by internal injuries. It is essential to identify the route of the wound and to take note of all potential internal injuries. Mortality associated with penetrating abdominal trauma is associated with the intra-abdominal organs injured, with internal bleeding being the leading cause of death.4TREATMENTAll types of abdominal trauma require medical intervention and/or surgical repair to prevent peritonitis and septic shock. In penetrating abdominal trauma, careful removal of the embedded object is critical and the closure of the wound must be properly and neatly done.2PREVENTIONWhen driving, traffic regulations must be conformed to at all times. 5 Seatbelt usage while riding a closed vehicle and avoidance of drinking alcohol when a person has to drive are certain preventive measures that can help prevent abdominal trauma. 1REFERENCES1 British Medical Journal. Assessment of Abdominal Trauma. Last accessed November 2011. http://group.bmj.com/products/journals
2 Fauci, et. al. Harrison’s Principles of Internal Medicine. The McGraw-Hill Companies. 17th edition. 2008. The USA. Chapter 293. Acute Intestinal Obstruction
3 Udeani J, et. al. Blunt Abdominal Trauma. Medscape. Last accessed November 2011. http://emedicine.medscape.com/article/1980980-overview#aw2aab6b2b2
4 Stanton-Maxey KJ, et. al. Penetrating Abdominal Trauma. Medscape. Last accessed November 2011. http://emedicine.medscape.com/article/2036859-overview#aw2aab6b2b6aa
5 World Health Organization. Road traffic injuries publications and resources. Geneva. 2004. Last accessed November 2011. http://www.who.int/violence_injury_prevention/publications/road_traffic/en/index.html