الفهرس 
Anatomy of the Abdomen
Operative managementOnly 14 pages are availabe for public view
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Abstract
Blunt abdominal trauma continues to be the most common cause of injury to the abdomen. It may result from motor vehicle crashes, pedestrians struck by a motor vehicle, assaults and falls.
Abdominal trauma may result in a variety of intra-abdominal and retro-peritoneal injuries ranging from innocuous to life-threatening. The spleen is the most frequently injured organ, the liver, kidneys, small and large intestines are the next most injured organs, respectively.
Failure to early recognize intra-abdominal hemorrhage and to successfully control bleeding from intra-abdominal organs leads to significant morbidity and mortality. The detection of intra-abdominal injuries begins with understanding of trauma mechanisms, physical examination findings with maintaining a high index of suspicion, and diagnostic testing.
Several trauma scoring systems are used for facilitating the decision-making process, documentation and epidemiology, quality of care and patient outcome evaluation and injury severity description. They are based predominantly on anatomic and physiologic data.
According to advanced trauma life support (ATLS) system initial management of patients with blunt abdominal trauma aims to identify and correct any immediate life threatening condition. Priorities include airway, cervical spine contour, breathing, circulation and hemorrhage control, dysfunction of the central nervous system and exposure of the patient. After that the attention is directed to the secondary survey to identify all additional pathology.
Physical examination remains the initial step in diagnosis and must be done for every part of the body, but it is unreliable and has limited utility under select circumstances (e.g. altered mental status or spinal cord injury). Thus, various diagnostic modalities such as laboratory investigations CT, focused abdominal sonography for trauma (FAST), diagnostic peritoneal lavage (DPL) and diagnostic laparoscopy have evolved to offer a means to accurate diagnosis. The specific tests selected are based on the clinical stability of the patient, the ability to obtain a reliable physical examination and the provider’s access to a particular modality.
Laboratory tests are of value in the evaluation of a patient with abdominal trauma include haematocrit, urine analysis and serum amylase.
The focused assessment with sonography for trauma (FAST) is used to identify the presence of free intraperitoneal fluid in hemodynamically unstable patients. It has the advantage of being rapid, cheap, non-invasive, does not require radiation, can be repeated over time, and can be performed in parallel to the initial assessment in the resuscitation room; however it may miss solid organ injury in the absence of haemoperitoneum and has limited retroperitoneal accuracy.
CT is an important diagnostic tool because of it is highly specific, non-invasive and repeatable. CT is indicated primarily for hemodynamically stable patients who are candidates for non-operative therapy, however, it is time consuming and expensive.
Diagnostic peritoneal lavage can detect the presence of intraperitoneal blood but it has low organ specificity. It is more sensitive than CT for detection of hollow visceral and mesenteric injuries. It is a safe, rapid, but it is invasivez does not exclude injuries to retroperitoneal structures and has high rate of non-theraputic laparotomies.
Diagnostic and therapeutic laparoscopy applied to carefully selected hemodynamically stable patients proved to be safe and technically feasible. It also reduced unnecessary laparotomies and had decreased hospital stay and costs. It had decreased pain, better cosmetic results, and earlier ambulation.
By the use of recent diagnostic tools Non-operative management for blunt injuries of solid organs is now the rule rather than the exception. Non-operative management avoids the morbidity and potential mortality of an unnecessary laparotomy. The requirements for non-operative management are haemodynamic stability without signs of peritonitis, close observation and repeated follow up U/S or CT scan.
Interventional radiology like angiography with embolization has been one of the most important adjuncts in non-operative management of trauma increasing its success rate up to 95%.
Indications for exploration of the abdomen are peritonitis, unexplained hypovolemia, and deterioration of findings during routine follows up.
Damage control surgery is defined as the rapid initial control of hemorrhage and contamination with packing and a temporary closure, followed by physiologic resuscitation in the intensive care unit (ICU), and subsequent reexploration and definitive repair once normal physiology has been restored.
Organs injured in BAT should be managed selectively according to type of organ injured, site and grade of injury.
Finally, all these methods led to improve prognosis and decrease morbidity & mortality caused by blunt abdominal trauma (BAT).