Table of contents
Blunt abdominal trauma
Background
Overview
Definition
Blunt abdominal trauma refers to a non-penetrating injury to the abdomen due to direct impact or force without penetration of the abdominal wall.
1
Pathophysiology
The pathophysiology of blunt abdominal trauma involves the transfer of energy from the external force to the abdominal organs, potentially causing damage such as contusions or ruptures.
1
Epidemiology
The incidence of abdominal trauma in Norway is estimated at 7.2 per 100,000 person-years.
2
Risk factors
Risk factors that can exacerbate the trauma include the force and direction of the impact, the patient's age and overall health, and the presence of pre-existing conditions.
3
Disease course
Clinically, patients may present with abdominal pain, tenderness, distension, and bruising. Other signs may include hypotension, rebound tenderness, and the presence of a seat belt sign. Potential complications include injury to solid organs such as the liver, spleen, and kidneys, which can lead to intra-abdominal bleeding or infection.
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Prognosis and risk of recurrence
The prognosis of blunt abdominal trauma largely depends on the severity of the injury, the organs involved, and the timeliness and effectiveness of the treatment provided.
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of blunt abdominal trauma are prepared by our editorial team based on guidelines from the American College of Emergency Physicians (ACEP 2024,2011), the European Association of Urology (EAU 2024), the Surgical Infection Society (SIS 2024), the Surgical Infection Society Europe (SIS-E/GAIS/WSES/WSIS/AAST 2024), the American Heart Association (AHA/ACC 2022), the World Society ...
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Diagnostic investigations
Initial evaluation
As per ACEP 2024 guidelines:
Use clinical judgment and hospital-specific protocols to decide between selective CT and whole-body CT in hemodynamically stable adult patients with blunt trauma.
B
Take into account age (> 65 years) for triage of older adult patients with trauma, as they have increased morbidity and mortality compared with similarly injured adults.
B
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CT
Angiography
Diagnostic procedures
Diagnostic laparoscopy
As per WSES 2022 guidelines:
Consider performing diagnostic laparoscopy in hemodynamically compensated patients with highly sensitive findings of bowel injury on CT.
C
Consider treating bowel injuries laparoscopically, based on the surgeon experience and logistics of the trauma center, if identified during diagnostic laparoscopy.
C
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Diagnostic peritoneal lavage
Medical management
Nonoperative management: as per ACC/AHA 2022 guidelines, initiate anti-impulse therapy, if clinically tolerated, and obtain repeat imaging within 24-48 hours of the initial imaging to reduce the risk of injury progression in patients with grade 1-2 blunt traumatic abdominal aortic injury without malperfusion.
B
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Antibiotic prophylaxis (nonoperative management)
Antibiotic prophylaxis (surgical management)
Thromboprophylaxis
Inpatient care
Clinical and laboratory monitoring: as per WSES 2022 guidelines, admit patients with high-risk mechanisms (handlebar, seatbelt sign) and non-specific CT findings for observation including serial clinical examination.
B
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Imaging monitoring
Therapeutic procedures
REBOA: as per ACEP 2024 guidelines, do not perform resuscitative endovascular balloon aortic occlusion over resuscitative thoracotomy routinely in adult patients with blunt trauma in cardiac arrest or periarrest.
D
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Blood product transfusion
Surgical interventions
Indications for laparotomy: as per WSES 2022 guidelines, perform prompt surgical exploration in the presence of highly specific CT findings such as extraluminal air, extraluminal oral contrast, or bowel-wall defects.
A
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Vascular injury repair
Specific circumstances
Patients with liver trauma
As per WSES 2020 guidelines:
Obtain eFAST for rapid detection of intra-abdominal free fluid.
A
Obtain CT with IV contrast as the gold standard in hemodynamically stable patients with trauma
A
, and in patients considered for nonoperative management of liver trauma. B
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Patients with pancreatoduodenal injury
Patients with kidney injury
Patients with ureteral injury
Patients with bladder injury