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Initial evaluation and management of blunt abdominal trauma in adults

Authors
Deborah B Diercks, MD, MSc
Samuel Clarke, MD
Section Editor
Maria E Moreira, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM

INTRODUCTION

Blunt abdominal trauma is regularly encountered in the emergency department (ED). The lack of historical data and the presence of distracting injuries or altered mental status, from head injury or intoxication, can make these injuries difficult to diagnose and manage. Victims of blunt trauma often have both abdominal and extra-abdominal injuries, further complicating care.

The initial evaluation and management of patients with blunt abdominal trauma are reviewed here. Discussions of penetrating abdominal trauma, the general management of the acutely injured adult, and ultrasound evaluation in patients with abdominal or thoracic trauma are found separately. (See "Initial evaluation and management of abdominal stab wounds in adults" and "Initial evaluation and management of abdominal gunshot wounds in adults" and "Initial management of trauma in adults" and "Emergency ultrasound in adults with abdominal and thoracic trauma".)

EPIDEMIOLOGY

Blunt abdominal trauma (BAT) accounts for the majority (80 percent) of abdominal injuries seen in the Emergency Department [1], and is responsible for substantial morbidity and mortality. The majority of BAT cases (75 percent) are related to motor vehicle collision (MVC) or auto versus pedestrian accidents [2]. Blows to the abdomen and falls are responsible for 15 and 6 to 9 percent, respectively [3]. Occult BAT may occur with child abuse and domestic violence. (See "Physical child abuse: Diagnostic evaluation and management".)

The prevalence of intra-abdominal injury among patients presenting to the emergency department with BAT is approximately 13 percent [1]. The spleen and liver are the most commonly injured solid organs in BAT [2,3]. Injuries to the pancreas, bowel and mesentery, bladder, and diaphragm, as well as retroperitoneal structures (kidneys, abdominal aorta), are less common but must also be considered.

MECHANISM OF INJURY

Several pathophysiologic mechanisms can occur in patients with blunt abdominal trauma [3,4]. A sudden and pronounced rise in intra-abdominal pressure created by outward forces can rupture a hollow viscus. Passengers wearing a lap-belt without a shoulder attachment can sustain injury from such a mechanism when the belt forcefully compresses the abdomen.

                        

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Literature review current through: Nov 2016. | This topic last updated: Wed Jul 06 00:00:00 GMT+00:00 2016.
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