A B D O M I N A L T R AU M A

BY
Elina Rahma

Perceptor:
D r ( C a n ) d r. H . Yu s m a i d i , S p . B ( K ) B D ,
FinaCS
DEFINITION

Abdominal trauma is damage to the structure which

is located between the diaphragm and pelvis injuries
caused by blunt or puncture wounds.
CLASSIFICATION

Abdominal trauma caused by two mechanisms that damage,

namely:

1. Blunt trauma
Merupakan abdominal trauma without penetrating into the
peritoneal cavity. Several mechanisms of blunt abdominal
trauma in the form of a direct collision (eg, hit the steering
wheel), shearing injury due to seat belts, deceleration injury.
 MECHANISM OF TRAUMA

 trauma Blunt

1. Compression
2. Shearing
3. deceleration

organ often injury is:

 Spleen: 40-55%
 Retroperitoneal: 15%
 Hepar : 35-45%
 Organ hollow
2. Trauma Penetrans
• An abdominal trauma with penetration into the
peritoneal cavity.
• Several mechanisms such traumapenetrans abdomen
abdominal stab wounds and gunshot wounds.
 trauma Penetrans

Injury organ most often struck:

liver (40%)
small intestine (30%)
wound pricker
diaphragm (20%)
colon (15%)
gut smooth (50%),
gut big (40%),
Gunshot wounds
heart (30%),
vascular (35%)
Based on the organ affected by abdominal trauma divided
by 2, namely:
1. Trauma to the solid organs (liver, spleen), with the
primary symptoms of bleeding
2. Trauma to the hollow organs (intestines, bile ducts)
with the main symptoms of peritonitis.
 Injury Intra-peritoneal organs
1. Solid (hepatic/ Lien)
Bleeding
intraperitoneal DPL (diagnostic Peritoneal
- stimulus peritoneal
(pains pressure *)
Lavasage)
- sign blood intra-perit, FAST (Focused Assessment
- sign bleeding with sonography for Trauma)
(shock-pale)

2. Hollow
(side  rectum)
peritonitis General
- painful
- defans
- painful pressure
- painful free*
- deaf hepatic
Injury Retro-peritoneal organs

1. Injury urethra
Trias: There is bleeding in OUE (meatalbleeding), hematoma
scrotum, RT : prostate Flying

2. Injury V.Urinaria : tide catheter -

- minimal hematuria and
no increase

3. Injury Kidney : tide catheter -

- hematuria, amount normal
Injury Retro-peritoneal organs

duodenum - Pankeas :

- Manifestation slow : peritonitis

- Air retroperitoneal
 ASSESSMENT PATIENT WITH ABDOMINAL
TRAUMA

anamnesis
 History trauma

Blunt : speed, type object, position victim post trauma

and damage vehicle result trauma,

 Penetrans : type weapon and distance,

 PHYSICAL EXAMINATION

 Inspection: Injury, lacerations, puncture wounds, colon /

omentum is out

 auscultation: Bowel sounds. Free blood in the peritoneal

could result in ileus (bowel sounds disappear)

 percussion

 palpation
 Examination wound
 Rate stability bone pelvis.

 Examination perineal, rectal and penis.

 Examination vaginal and luteal.

 INSTALLATION NGT and
CATHETERS
 Installation NGT and catheter urine often done as part from stages
resuscitation,
Objective: eliminate dilatation of the stomach, gastric emptying
Counter indication installation NGT→fractures base cranial,

 Installation catheter urine:

- monitor diuresis
Overcoming retention
- decompression v. urinaria before DPL
 radiologically

 Routine
ATLS standard X-ray examination:
- lateral cervical photo
- thoracic AP
- pelvis AP
 Additional
- AP abdomen photo
- contrast
 DIAGNOSTIC SPECIAL

 Blunt trauma
DPL (Diagnostic Peritoneal Lavage)
ultrasound
CT scan

 trauma penetrans
anterior → wound exploration
posterior → x-ray + contrast.
 MODALITY DIAGNOSTIK

I. FAST
II. DIAGNOSTIC PERITONEAL lavage (DPL)
III. Abdominal CT - SCAN
IV. laparoscopy
 DPL ultrasou CT
Indication Determine presence nd
Determine fluid Determining organ
bleeding when when BP injury when normal
BP BP

profit diagnosis fast and diagnosis fast; no The most specific to

sensitive; accuracy 98% invasive and could the injury; accuracy
is repeated; of 92% -98%
accuracy 86% -97%
Loss Invasive, fail to dependent operator Need cost & time
acknowledge the distortion gas gut pliers more long, no
diaphragm injury or and air below skin, knowing injury
injury retroperitoneum Failed knowing diaphragm, gut and
injury diaphragm pancreas
gut, pancreas
 INDICATION OF OPERATION

A. Indications based on the evaluation of the abdomen

1. Blunt abdominal trauma with DPL +

2. Blunt abdominal trauma with hypotension recurs after fluid
resuscitation
3. peritonitis difusa
4. Hypotension with penetrating injuries
5. Bleeding from the stomach, anus, tr.ur inarius penetrating
wounds
6. Gunshot wound through the peritoneal cavity or
retroperitonium
7. Eviscerasi
A.Indications by the X-ray inspection

1. Free air, air retroperitoneal or ruptured diaphragm due to

blunt trauma
2. + Contrast CT scan shows a hollow organ perforation due to
blunt trauma and penetrans
 Penetrating Abdominal Trauma

 Sores that look does not

reflect the severity of the
injury
 The possibility of
significant bleeding
 The chances of
developing bowel
 Patients may shock
 Evisceration

Extrusion of abdominal contents secondary to

penetrating abdominal trauma
 management Evisceration Injuries

 Use a sterile bandage To place an organ that came

out near the wound (NOT to smb wound)
 Cover completely with organ & wound moist and
sterile bandage
 PRESSURE TO DO create or ORGAN YG EXIT
WOUNDS
 Wound around a loose bond

 Prepare For surgery

 SPECIAL ISSUE

 diaphragm
rip trauma blunt more often hemidiafragma left, big
rip 5-10 cm, posterolateral

 duodenum
rip on duodenum occur on driver motorized that no
use belt safety and crash frontal.
 ruptured spleen

-Riwayat sharp or blunt trauma

-Headache in the upper abdomen
-There lesion in the left hip or left upper abdomen
General-mark hemorrhage (hypotension, tachycardia,
anemia)
Mass-mark in the upper left abdomen
-Sign free fluid within the abdominal cavity
 Pancreas
Injury pancreas most often result trauma live in the
epigastric push to bone back,

A history of trauma: stomach hit the steering wheel,

motorcycle handlebar, punches, kicks, or stab wounds and
gunshot wounds to the epigastric region.

Clinical features: heartburn, a sign of peritoneal irritation is

often unclear, increasing abdominal bloating.

CT scan + contrast maybe no show sign trauma pancreas

that mean when done immediately after injury,
 TRAUMA PELVIC

 Pelvic trauma usually due to collision of cars and

pedestrians, motorcycles.
 Pelvic fractures have strong relationships with
injuries on intraperitoneal and retroperitoneal
structures and vascular structures
 AP compression mechanism of trauma, lateral or
vertical compression.
THANK YOU