Initial evaluation and management of blunt abdominal trauma in adults
- Deborah B Diercks, MD, MSc
Deborah B Diercks, MD, MSc
- Professor and Chair of Emergency Medicine
- University of Texas Southwestern, Dallas
- Samuel Clarke, MD
Samuel Clarke, MD
- Assistant Professor, Department of Emergency Medicine
- University of California, Davis
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".)
Blunt abdominal trauma (BAT) accounts for the majority (80 percent) of abdominal injuries seen in the Emergency Department , 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 . Blows to the abdomen and falls are responsible for 15 and 6 to 9 percent, respectively . 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 . 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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- MECHANISM OF INJURY
- EVALUATION AND MANAGEMENT
- Initial assessment and examination
- Laboratory tests
- Radiologic studies
- - Warnings
- - Plain radiographs
- - Computed tomography
- - Ultrasound
- - Angiography
- Diagnostic peritoneal lavage (DPL)
- MANAGEMENT BY CLINICAL SCENARIO
- Hemodynamically unstable patient
- Hemodynamically stable patient
- Clinical indications for laparotomy
- Special considerations
- - Pelvic fracture
- - Multiple system injury
- - Closed head injury
- - Transfers
- - Pregnant patient
- - Geriatric patient
- SUMMARY AND RECOMMENDATIONS