Blunt Abdominal Trauma (Abdomen Injury)

What is Blunt Abdominal Trauma (Abdomen Injury)?

Blunt force trauma to the abdomen is a common reason adults and children end up in the emergency department.

What Causes Blunt Abdominal Trauma (Abdomen Injury)?

The main reason for severe abdominal injuries in the United States is car crashes. There are a few other less common causes, such as falls from high places, bicycle accidents, sports-related injuries, and workplace accidents. Among kids, car accidents and bicycle mishaps are the more usual causes of such injuries.

Risk Factors and Frequency for Blunt Abdominal Trauma (Abdomen Injury)

Blunt trauma, or a forceful hit, to the abdomen can affect anyone, regardless of age, and often leads to serious health problems. Every year, emergency departments see thousands of patients with these type of abdominal injuries. This significantly adds to the overall cost of healthcare.

Signs and Symptoms of Blunt Abdominal Trauma (Abdomen Injury)

Diagnosing abdominal injuries can be challenging because the signs are not always clear. Aside from pain, a person with an abdominal injury may experience rectal bleeding, fluctuating vital signs, and inflammation in the lining of their abdomen, known as peritonitis. Physical examination could reveal various signs like seatbelt marks, bruises, a bloated belly, no sound from the stomach, and tenderness. If there’s peritonitis, the abdomen may be hard, protected and sensitive to touch. Factors like the cause of the injury, the speed of any involved vehicle, associated fatalities, and use of alcohol or drugs should be considered to prevent missing any injuries. One notable sign, the Cullen’s sign, is bruising around the navel that occurs when bleeding from the back of the abdomen moves along a certain band of tissue towards the front.

Testing for Blunt Abdominal Trauma (Abdomen Injury)

The first step in assessing a trauma patient involves checking their airway, inspecting their breathing, and managing their blood circulation. The primary mode of diagnosing an internal injury in the abdomen or pelvis after a blunt trauma incident depends largely on the patient’s hemodynamic status, or the stability of their blood circulation. If they are stable, a CT scan is generally the go-to method because it can accurately detect potential injuries to the solid organs in the abdomen and pelvis.

However, if a patient is unstable, doctors might resort to less accurate methods such as an ultrasound or a diagnostic peritoneal lavage. These tests are often used when there’s a suspicion of internal bleeding, fluid build-up around the heart (pericardial tamponade) or blood in the chest cavity (hemothorax) resulting from a trauma to the torso.

The Extended Focused Assessment with Sonography for Trauma, or EFAST, is one such ultrasound exam that includes several different views of the abdomen and chest:

1. The right upper quadrant, where doctors look for free fluid in spaces between the liver and kidney, and below the diaphragm.
2. The area around the spleen and the left upper quadrant, where doctors check for free fluid in the left chest cavity. Fluid usually flows into a certain area above the diaphragm, which may be hard to see because of gas in the bowel and the curvature of the spleen.
3. The pelvis and bladder, where they can check the area with the rectum, prostate or uterus, as well as the most fluid-accumulating areas: the microvesicular area in men and the pouch of Douglas in women.
4. The heart, in what’s called a subcostal or any other cardiac view. This allows them to check for fluid in the sac around the heart or pericardium.
5. The lungs, which should normally slide back and forth due to the movement of the chest lining or pleura. If there’s a presence of air in the chest cavity or pneumothorax, there will be no lung sliding, and the pleura and ribs will appear to move together with no comet tail artifacts.

The images obtained from these views are critical in evaluating the condition of a trauma patient and providing appropriate medical attention.

Treatment Options for Blunt Abdominal Trauma (Abdomen Injury)

Treating patients with a blunt abdominal injury begins with the standard procedure known as the ABCs, which stands for Airway, Breathing, and Circulation. After ensuring their airway is clear, it’s crucial to protect their neck, as there could be injuries to the cervical spine. Once these initial checks are done, patients with low blood pressure will need vigorous fluid replacement to help their bodies cope.

If their unstable blood pressure continues, their blood should be tested and matched for a potential transfusion. However, while waiting for the results, they can be given a universal donor blood type, O negative (or O positive for men and older women who are past their child-bearing years).

Patients who show signs of internal damage, such as inflammation of the membrane lining the abdominal cavity (peritonitis), visible bleeding, or worsening symptoms, will need immediate abdominal surgery (laparotomy). However, the need for surgery also depends on factors like the patient’s overall condition, stable blood pressure, and the findings from a CT scan.

In recent years, medical advancements like angiography—an imaging technique to visualize the blood vessels—have been helpful in controlling bleeding. This method, known as embolization therapy, can stop the bleeding by blocking the blood vessel and is usually more cost-efficient than surgery.

Generally, patients with blunt abdominal trauma have a good prognosis, meaning their chance of recovery is high.

What else can Blunt Abdominal Trauma (Abdomen Injury) be?

• Abuse at home (domestic violence)
• Stroke with bleeding (hemorrhagic stroke)
• Shock due to severe fluid loss or blood loss (hypovolemic shock)
• Injury to lower urinary and reproductive organs (lower genitourinary trauma)
• Deep internal injuries in the abdomen (penetrating abdominal trauma in emergency medicine)
• Injuries during pregnancy
• Injuries to upper urinary and reproductive organs (upper genitourinary trauma)

Possible Complications When Diagnosed with Blunt Abdominal Trauma (Abdomen Injury)

• Not getting enough fluid resuscitation
• Overlooked injuries to the abdomen
• Delays in identifying and treating the issue
• Widespread infections inside the abdomen
• Late occurrence of spleen rupture

Preventing Blunt Abdominal Trauma (Abdomen Injury)

It’s essential for everyone’s safety to adopt certain practices while driving. These include always wearing a seat belt, refraining from texting or using your mobile phone while behind the wheel, and never driving under the influence of alcohol. Each of these actions significantly reduce the risk of accidents and ensure safer roads for all.