Intended for healthcare professionals

Practice ABC of Major Trauma, 4th Edition

Abdominal Trauma

BMJ 2014; 348 doi: (Published 12 March 2014) Cite this as: BMJ 2014;348:bmj.g1140
  1. Munawar Al-Mudhaffar,
  2. Philip Hormbrey
  1. John Radcliffe Hospital Oxford, UK

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  • The resuscitation of abdominal trauma patients should follow the ABCDE pathway to identify and treat life-threatening injuries.

  • The shocked multiple trauma patient who fails to respond to fluid therapy and in whom there is no obvious bleeding source in the thorax, and no pelvic or long bone fracture is identified, should be presumed to have bleeding in the abdomen until proved otherwise.

  • While focusing on resuscitation, the aim in abdominal trauma should be to identify patients who need immediate laparotomy.

  • Establishing the mechanism of injury, meticulous physical examination and appropriate use of special investigations such as ultrasound, diagnostic peritoneal lavage and computed tomography will help to avoid missing abdominal injuries.

  • A high index of suspicion should be maintained to avoid missing perineal and retroperitoneal injuries.

Evaluation of the abdomen in trauma is a challenge because of the physical extent of the abdominal cavity, the paucity of clinical signs and the difficulties associated with the main modes of investigation. Death secondary to uncontrolled and sometimes unrecognised haemorrhage is common. To avoid missing significant injuries, one must assume that every major trauma patient has suffered an abdominal injury unless the patient is awake, has no abdominal pain or distracting injuries and has normal vital signs. Abdominal trauma needs surgical expertise. Call for surgical aid as soon as you suspect abdominal trauma.

Anatomical considerations

The abdomen extends anteriorly from the nipple line (at the fourth intercostal space) down to the inguinal creases and posteriorly from the inferior border of the scapulae down to the gluteal …

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