1. Abdominal trauma
By:
Mohamed Soliman El-Sheshtawy
Faculty of Medicine
Alexandria .Egypt.
http://www.facebook.com/sheshto2014

2. 1- Introduction
2-causes
3-symptoms and signs
4-management

3. Introduction
-Abdomen is a black box
i.e it is impossible to know what special injuries
have occurred
-Our aim to save lives in Abdominal Trauma not
to make an accurate diagnosis
-Don’t spend the precious time of the victim in
sophisticated investigation.

4. Types of the abdominal trauma.
1-Blunt abdominal trauma.
2-Penetrating abdominal trauma.

5. Blunt Trauma

6. penetrating

10. Penetrating Abdominal Trauma is usually
diagnosed based on clinical signs, blunt
abdominal trauma is more likely to be missed
because clinical signs are less obvious.

11. Symptoms and signs
1-Penetrating Trauma:
Abdominal pain
Bleeding
Shock
Impalement Injury
Evisceration

12. Evisceration

14. 2-Blunt Trauma:
Abdominal pain
Distension
Discoloration of abdomen
Unexplained shock

15. Examination and Evaluation
1- visually note wounds and abrasions
2-palpate abdomen for localized and diffuse
tenderness
3-consider possible internal injuries eg: liver
,spleen and kidney
4-diffuse severe tenderness: a sign of internal
bleeding.

16. Liver injury

17. Kidney Injury

18. signs
Cullen’s Sign:1918
Bluish discoloration around umbilicus
Diffusion of blood along periumbilical
tissues or falciform ligament
Hemoperitoneum
Severe pancreatitis

19. Grey-Turner’s Sign: (1877-1951)
Bluish discoloration of the flanks
Retroperitoneal Hematoma
hemorrhagic pancreatitis.

20. Kehr’s sign (1862-1916).
Referred pain in left shoulder
irritation of the diaphragm
(Splenic injury, free air,
intra-abdominal bleeding)

21. Balance’s Sign
Dullness on percussion of the left upper quadrant
ruptured spleen

22. Labia and Scrotum : Pooling of blood from
abdominal and pelvic cavities and you should
Examine the back.

23. Diaphragmatic injuries
Diaphragmatic injuries are difficult to diagnose.
Small diaphragmatic injuries on the right side
may heal without incident, and the liver
protects against potential hernias. Small
injuries on the left side may result in
symptomatic diaphragmatic hernias. Acute
diaphragmatic defects are best approached
through the diaphragm

24. Diaphragmatic Injury:
respiratory paradox “inward
movement of abdomen during
Inspiration.

25. Managment

26. Primary survey
Identification & treatment of life
threatening conditions
• Airway , with cervical spine precautions
• Breathing
• Circulation
• Disability
• Exposure

27. Emergency Care
• I V fluids
• Control external bleeding
• Dressing of wounds
• Protect eviscerated organs with a sterile dressing
• Stabilize an impaled object in place
• Give high flow oxygen
• Immobilize the patient with a fractured pelvis
• Keep the patient warm
• Analgesics

28. Secondary Survey
• General &Systemic Examination-to identify
all occult injuries .
• Special attention to Back, Axilla , Perineum
• PR - sphincter tone ,bleeding ,perforation
, high riding prostate
• Foley’s catheter- monitor urine out put
• Nasogastric tube

29. Secondary Survey(cont.)
• AMPLE History
• A: Allergy
• M: Medications
• P: Past medical history
• L: Last meal
• E: Event - What happened

30. (Investigations)
(A) Blood Tests
(B) Radiological Studies
(Plain abdominal X-ray,
CXR)
(C) Peritoneal lavage (DPL)
(D) USS abdomen
(E) CT abdomen
(F) Peritoneoscopy (Diagnostic
laproscopy)

31. X-ray

32. Post traumatic diaphramatic hernia

33. Diagnostic peritoneal lavage

35. C.T
Liver trauma

37. Splenic injury

38. Splenic injury

39. Pancreatic injury

40. Ultra-sound
Splenic injury

41. Thank you

42. References
Schwartz_Principles-of-Surgery_9th-Edition
Sabiston 18th Edition
Bailey and love
EssentialSurgery Problems Diagnosis And
Management 4thEdition
Radiology_for_Surgeons_in_Clinical_Practice