Most common organ injured in blunt injury:
Ref: Emedicinc Medscape online, Shah SM, Shah KS, Josh) PK Somani RB. Gohil VB. Dakhda SM. To study the incidence of organ damage and post - operative care in patients of blunt abdominal trauma with haemoperitoneum managed by laparoscopy. J Minim Access Surg. 2011 Jui:7(3): 169-72. Sabiston, Bailey & SchwartzExplanation:Both Spleen & Liver are the most common organs to be injured in blunt injury abdomen."The spleen is the most commonly injured abdominal organ in the NTDB( national Trauma database) with 3.2% of all injured patients and 50.7% of patients with blunt abdominal trauma demonstrating splenic injuries "- Pg 457 Sahiston"Second only to the spleen. injury to the liver is extremely common after blunt abdominal trauma. " Pg 459 Sahiston."The most commonly injured organs are the spleen, liver, retroperitoneum, small bowel, kidneys, bladder, eoloreefum, diaphragm, and pancreas " (Ref: Medscape emedicinc online)Liver followed by the spleen were the most common sites of injuries.(Ref: Shah et al.)Spleen is the most common damaged organ in blunt abdominal trauma (Ref: Schwartz)Liver injuries are fortunately uncommon because of the liver s position under the diaphragm protected by chest wall. (Ref: Bailey)Blunt abdominal traumaPathophysiologyBlunt force injuries to the abdomen can generally be explained by 3 mechanisms.Deceleration.Crushing.External compression.Signs and symptomsThe initial clinical assessment of patients with blunt abdominal trauma is often difficult and notably inaccurate. The most reliable signs and symptoms in alert patients are as follows:PainTendernessGastrointestinal hemorrhageHypovolemiaEvidence of peritoneal irritationBradycardia may indicate the presence of free intraperitoneal blood.On physical examination, the following injury patterns predict the potential for intra-abdominal trauma:Lap belt marks: Correlate with small intestine ruptureSteering wheel-shaped contusionsEcchymosis involving the flanks (Grey 't urner sign) or the umbilicus (Cullen sign!: Indicates retroperitoneal hemorrhage, but is usually delayed for several hours to daysAbdominal distentionAuscultation of bowel sounds in the thorax: May indicate a diaphragmatic injuryAbdominal bruit: May indicate underlying vascular disease or traumatic arteriovenous fistulaLocal or generalized tenderness, guarding, rigidity, or rebound tenderness: Suggests peritoneal injuryFullness and doughy consistency on palpation: May indicate intra-abdominal hemorrhageCrepitation or instability of the lower thoracic cage: Indicates the potential for splenic or hepatic injuriesDiagnosisAssessment of hemodynamic stability is the most important initial concern in the evaluation of a patient with blunt abdominal trauma.In the hemodynamicallv unstable patient, a rapid evaluation for hemoperitoneum can be accomplished by means of diagnostic peritoneal lavage (DPL:i or the focused assessment with sonography for trauma {FAST}.Radiographic studies of the abdomen are indicated in stable patients when the physical examination findings are inconclusive.Diagnostic peritoneal lavageDPL is indicated for the following patients in the setting of blunt trauma:Patients with a spinal cord injuryThose with multiple injuries and unexplained shockObtunded patients with a possible abdominal injuryIntoxicated patients in whom abdominal injury is suggestedPatients with potential intra-abdominal injury who will undergo prolonged anesthesia for another procedureFASTBedside ultrasonography is a rapid, portable, noninvasive. and accurate examination that can be performed by emergency clinicians and trauma surgeons to detect hemoperitoneum.The current FAST examination protocol consists of 4 acoustic windows (pericardiac, perihepatic, perisplenic, pelvic) with the patient supine.An examination is interpreted as positive if free fluid is found in any of the 4 acoustic w indows, negative if no fluid is seen, and indeterminate if any of the windows cannot be adequately assessed.Computed tomographyComputed tomography is the standard for detecting solid organ injuries.Provide excellent imaging of the pancreas, duodenum, and genitourinary system.CT scanning often provides the most detailed images of traumatic pathology and may assist in determination of operative interventionAlso can determine the source of hemorrhage.ManagementTreatment of blunt abdominal trauma begins at the scene of the injury and is continued upon the patient's arrival at hospitalManagement may involve nonoperative measures or surgical treatment, as appropriate.Indications for laparotomySigns of peritonitisUncontrolled shock or hemorrhageClinical deterioration during observationHemoperitoneum findings on FAST or DPLNonoperative managementIn blunt abdominal trauma, including severe solid organ injuries, selective nonoperative management has become the standard of cure. Nonoperative management strategies are based on CT scan diagnosis and the hemodynamic stability of Ihe patient, as follows:For ihe most part, pediatric patients can be resuscitated and treated nonoperatively; some pediatric surgeons often transfuse up to 40 mL/ kg of blood products in an effort to stabilize a pediatric patientHemodynamically stable adults with solid organ injuries, primarily those to the liver and spleen, may be candidates for nonoperative managementSplenic artery embolotherapy, although not standard of care, may be used for adult blunt splenic injury
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Abdominal Injury