Abdominal injury
Penetrating injuries usually require a prompt laparotomy. Assess the degree of penetration (if uncertain) under local anaesthetic, by extending the wound, if necessary. Ask for expert assistance with this. Laparotomy is indicated if the posterior rectus sheath is breached.
Blunt trauma : Suspect injury to spleen, kidney, liver, or pancreas. Deceleration forces may tear the liver from the inferior vena cava, the bowel from its mesentery, or the bladder from the bladder neck.
Signs of damage to organs : Ruptured spleen suggested by shock,abdominal tenderness and distension, left shoulder tip pain.
Any visceral injury may cause bruising in the flanks,absent bowel sounds and muscular spasm. GU injury is a suggested by haematuria.
- Treat shock vigorously; crossmatch blood.
- If the patient does not respond quickly take straight to theatre for exploratory laparotomy (after urgent CXR to rule out pneumothorax and after passing of a nasogastric tube).
- Take base line observations of pulse, BP, respirations, temperature, abdominal girth; and urine output.
- Consider peritoneal lavage or diagnostic tap. Use a 21 gauge needle, introduce into the left iliac fossa. Inject 20 ml saline and withdraw. Is the fluid blood-stained?
- Look for blood at the tip of the urethra signifying ruptured urethra. Seek expert urological help in planning urethral repair. Rarely GU trauma will require ureteroureterostomy, ureteroneocystostomy, or even kidney autotransplanation.
- Examine urine for frank or microscopic haematuria.
- Arrange a prompt exploratory laparotomy if there is:
i)Shock (eg.,ruptured spleen) ii)Penetration to unknown extent
iii)Peritonism (ruptured viscus) iv)Air under the diaphragm on X-ray
( A non-functioning kidney on IUV is a relative indication)
8. Tests: FBC (raised WCC suggests ruptured spleen), U&E,amylase.
9. Radiology: Erect (or decubitus) and abdominal films; CXR (for fractures); pelvis; Spine; IVU; other injured sites.
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