Abdominal trauma occurs when the structure and organs of the abdominal cavity are injured through falls, car accidents or deliberate acts of violence. Abdominal trauma accounts for approximately 8% of all serious trauma in NSW.
The structures contained in the abdomen include the gastrointestinal system (stomach, liver, pancreas, and intestines), the renal system (kidneys), the spleen and arteries and veins including the aorta.
Source: Family Doctor UK
What is abdominal trauma?
Abdominal trauma is generally categorised as blunt or penetrating trauma.
Blunt abdominal trauma typically results in injury to solid organs eg liver, spleen, kidneys and pancreas. Hollow organs eg stomach, intestines, bladder tend to be compressible but may rupture. Road crashes, falls, assaults and industrial accidents cause the majority of blunt trauma. The injuries are caused when the abdominal organs are compressed against the backbone, or when internal structures are stretched at their attachments.
Penetrating trauma typically results in injury to organs in the direct path of the instrument or missile, but high-velocity weapons may cause injury to adjacent organs as well.
Treatment for abdominal trauma
Hospital treatment for abdominal trauma begins with a rapid assessment in Emergency. Suspected haemorrhage will be identified quickly using clinical assessment and an abdominal ultrasound. Patients identified as suffered a life threatening haemorrhage are rapidly transported to theatre for definitive surgery. Other injuries will be identified after this. Chest and abdominal x-rays may indicate disruption of the gastrointestinal tract or may identify penetrating objects. CT scans are used to detect solid organ lacerations or haematomas An angiogram (x-ray scanning using dye to look at the blood flow in blood vessels) may be used to detect haemorrhage from pelvic blood vessels, if there is a pelvis fracture. A range of blood tests will be done including haemoglobin (Hb).
There are a number of operations that may be performed according to the findings at operation. Below is a short list of common terms that may be of use.
- Laparotomy - an exploratory operation where the surgeons look for problems and operate according to their findings.
- Laproscopy - an exploratory operation performed using key hole surgery.
- Splenectomy - removal of the spleen.
- Nephrectomy - removal of a kidney.
- Anastomosis - surgical procedure where two parts of the bowel are joined together.
What Happens in Intensive Care?
A patient with abdominal trauma will be admitted to Intensive Care if they have suffered a severe injury. They may have experienced trauma to a number of other body areas (classified as multi-trauma). On most occasions the patient will be admitted to the Intensive Care following surgery. Once in ICU the patient will be under the care of the Intensive Care team with the surgical team reviewing the patient on a regular basis.
The care in Intensive Care will be focussed on monitoring and supportive measures. The patient will be connected to a patient monitor for close monitoring of their vital signs including heart rate, blood pressure, breathing rate, temperature and oxygen saturation. An arterial line may be used for continuous monitoring of blood pressure and taking blood tests. The patient's breathing will be supported by additional oxygen via an oxygen mask, however the patient may be on a ventilator and have a breathing tube inserted into their airway. They will be receiving intravenous fluids via several intravenous cannulas or central line. A urinary catheter is used to monitor urine output and a nasogastric tube will be used to rest the intestine if this has been injured or if the patient is ventilated. Anti-thrombotic stockings will be applied to guard against the development of a deep vein thrombosis (DVT) in the lower limbs. A sequential compression device may also be used. Pain medication will be given to ensure they are as pain free as possible. If the hospital has a pain teamâ€™ they will become involved to further ensure pain relief is optimised. Nutrition will be started as early as possible. Feeding via a nasogastric tube is preferred. However if this is not possible, the patient will be fed intravenously.
- Haemorrhage can result in shock and complications associated with massive blood transfusions. Delayed haemorrhage from liver or spleen bruising tends to occur several days after the initial injury.
- Infection: intra-abdominal infection can be a significant problem. Predisposing factors include injury to the intestines, open wounds, delayed diagnosis of hollow organ injuries, and large amount s of damaged tissue.
- The stomach and intestines often fail to work for a variable time after injury. This causes problems such as delayed stomach emptying and paralytic ileus (paralysed bowel).
- Severe haemorrhage, bowel swelling or bowel paralysis can lead to a high intra-abdominal pressure as the fluid collects inside the abdomen. This can make it more difficult for a patient to breathe because of increasing size and pain. Sometimes the pressure inside the abdomen may need an operation to reduce it and afterwards the surgeons use a mesh repair or leave the abdomen open. Repeated operations are required and the abdomen is closed in stages.
How long will the patient remain in Intensive Care?
This is a difficult question to answer and all depends on the patientâ€™s initial injuries and subsequent complications. Please direct questions regarding a specific patient to the intensive care and surgical staff.
The information contained on this page is general in nature and therefore cannot reflect individual patient variation. In addition it reflects Australian intensive care practice which may differ from other countries. It is meant as a back up to specific information which will be discussed with you by the Doctors and Nurses caring for your loved one. ICCMU attests to the accuracy of the information contained here BUT takes no responsibility for how it may apply to an individual patient. Please refer to the full disclaimer.
- First published in December 2005
- Written by Angela Berry CNC Westmead Hospital, Westmead, NSW, Australia
- Edited by Kaye Rolls Clinical Project Officer ICCMU and CWPWP