Abdominal injuries

1. Big picture

Abdominal injury is a potentially life-threatening trauma because the abdomen can hide massive bleeding, hollow viscus perforation, bile/pancreatic leakage, and retroperitoneal injuries with initially subtle signs.

In the surgery oral exam, the most important decision is not “which organ is injured?” first. The first question is:

Is the patient hemodynamically stable or unstable?

That determines the whole diagnostic and therapeutic pathway.

Abdominal trauma
        ↓
Primary survey: ABCDE
        ↓
Hemodynamic status?
        ↓
Unstable → resuscitate + FAST → laparotomy if intra-abdominal bleeding suspected
        ↓
Stable → CT with IV contrast → selective operative / non-operative / interventional management

The abdomen must always be considered in polytrauma, especially after road traffic accidents, falls, crush injury, stab wounds, gunshot wounds, and blast injury.

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