Advances in Abdominal Trauma

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Emergency practitioners routinely encounter patients who suffer from abdominal trauma, be it blunt or penetrating. These injuries are often confounded by altered mental status, distracting injuries, or lack of historical information, and may present challenges in management. However, in the last several years new approaches to the diagnosis and management of abdominal trauma, including bedside ultrasound, newer generation computed tomography scans, laparoscopy, and the ability for selected nonoperative management expedite identification of life threatening injury and offer new options in treatment.

Section snippets

Background

Historically, blunt abdominal trauma (BAT) is more frequently encountered in the emergency department (ED) than penetrating abdominal trauma, and usually results from a motor vehicle collision (MVC). When combined with pedestrian versus auto accidents, these types of abdominal traumas account for up to 75% of cases seen, while direct abdominal blows and falls comprise the remainder [1], [2]. The spleen is the most often injured organ and may be the only intra-abdominal injury in over 60% of

Background

Penetrating trauma is increasing because of the growth of violence in our society. Stab wounds are encountered three times more often than gunshot wounds, but have a lower mortality because of their lower velocity and less invasive tract. As a result of their greater force and extensive missile tract, gunshot wounds account for up to 90% of the mortality associated with penetrating abdominal trauma. Injury to the bowel (small, then large) is most often found, followed by hepatic injury,

Summary

Several advances in diagnostic modalities challenge the traditional dogmatic approach to abdominal trauma. Ultrasonography is now routinely used in the initial assessment of those with blunt abdominal trauma, and its role in penetrating trauma is being defined. Improved CT resolution with multislice and helical CT scanners allows for better identification of injuries with improved ability to grade their severity. This in turn, offers a nonoperative approach for certain patients with penetrating

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