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Blunt abdominal trauma

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.
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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.
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Epidemiology
The incidence of abdominal trauma in Norway is estimated at 7.2 per 100,000 person-years.
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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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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 Surgical Infection Society Europe (SIS-E/GAIS/WSES/WSIS/AAST 2023), the World Society of Emergency Surgery (WSES 2022; 2020; 2017), the American Heart Association (AHA/ACC 2022), the European Association of Urology (EAU 2022), the World Society of Emergency Surgery (WSES/AAST 2020; 2019), the Eastern Association for the Surgery of Trauma (EAST 2019; 2012), the American Urological Association (AUA 2014), and the American College of Emergency Physicians (ACEP 2011).
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Guidelines

1.Diagnostic investigations

Initial evaluation: as per WSES 2022 guidelines, obtain a primary survey, eFAST, perform a physical examination, obtain a secondary survey, blood chemistry, check for vital signs followed by contrast-enhanced abdominal CT in awake and oriented patients with blunt abdominal trauma.
A
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  • CT

  • Angiography

2.Diagnostic procedures

Diagnostic laparoscopy
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

3.Medical management

Nonoperative management: as per ACC 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

  • Thromboprophylaxis

4.Inpatient care

Serial clinical and laboratory assessment: 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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  • Serial imaging assessment

5.Therapeutic procedures

Resuscitative endovascular balloon occlusion of the aorta
As per ACC 2022 guidelines:
Insufficient evidence regarding the usefulness of the routine use of REBOA for hemorrhage control in patients with blunt traumatic abdominal aortic injury, and even it may cause harm in some cases.
I
Insufficient evidence regarding the usefulness of the routine use of REBOA for hemorrhage control in patients with blunt traumatic abdominal aortic injury, and even it may cause harm in some cases.
I

6.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

7.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

8.Follow-up and surveillance

Discharge from hospital: discharge clinically stable patients with isolated blunt abdominal trauma after a negative result for abdominal CT with IV contrast, with or without oral contrast.
B

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  • Follow-up