Abdominal Injuries
LIFE-THREATENING DISORDERBlunt and penetrating abdominal injuries may damage major blood vessels as well as internal organs. Their most immediate life-threatening consequences are hemorrhage and hypovolemic shock; later threats include infection. The prognosis depends on the extent of the injury and on the organs damaged, but it’s generally improved by prompt diagnosis and surgical repair.
Causes
Blunt (nonpenetrating) abdominal injuries usually result from motor vehicle accidents, falls from heights, or athletic injuries; penetrating abdominal injuries, from stab or gunshot wounds.
Signs and symptoms
Depending on the degree of injury and the organs involved, signs and symptoms vary as follows:
Penetrating abdominal injuries cause obvious wounds. For example, gunshots commonly produce both entrance and exit wounds, with variable blood loss, pain, and tenderness. These injuries can cause pallor, cyanosis, tachycardia, shortness of breath, and hypotension.
Blunt abdominal injuries can cause severe pain (such pain may radiate beyond the abdomen, for example, to the shoulders), bruises, abrasions, contusions, and distention. They may also result in tenderness, abdominal splinting or rigidity, nausea, vomiting, pallor, cyanosis, tachycardia, and shortness of breath. Rib fractures commonly accompany blunt injuries.
With both penetrating and blunt injuries, massive blood loss may cause hypovolemic shock. Generally, damage to a solid abdominal organ (liver, spleen, pancreas, or kidney) causes hemorrhage, whereas damage to a hollow organ (stomach, intestine, gallbladder, or bladder) causes rupture and release of the affected organ’s contents (including bacteria) into the abdomen, which, in turn, produces inflammation.
Diagnosis
A history of abdominal trauma, signs and symptoms, and laboratory results confirm the diagnosis and help determine organ damage. Consider any upper abdominal injury a thoracicoabdominal injury until proven otherwise. Diagnostic studies vary with the patient’s condition but usually include:
