Curriculum · Surgery
Management of abdominal trauma
What it is
Management of abdominal injury depends on three things together: the hemodynamic status, the FAST, and the CT findings.
How it is diagnosed
FAST is always done after resuscitation, alongside the other adjuncts of CXR and pelvis x-ray. CT comes next only if the patient is stable; if the patient did not respond to resuscitation, take him immediately to OT instead. CT tells you the exact source of bleeding, whether there is retroperitoneal bleeding, and whether there are multiple sources of bleeding. Laparoscopy does not show the retroperitoneum, so posterior penetrating trauma with a query bowel injury is worked up with a triple phase CT scan and rectal contrast to examine the colon.
Grading the injured spleen
The spleen injury is set out by Grade, on what the laceration measures and how much of the surface area the hematoma covers:
- Grade I: laceration < 1 cm; subcapsular hematoma < 10% of surface area
- Grade II: laceration 1-3 cm; subcapsular hematoma 10-50% of surface area
- Grade III: laceration > 3 cm; subcapsular hematoma >50% of surface area; ruptured subcapsular or parenchymal hematoma
- Grade IV: segmental or hilar vascular injury; devascularization > 25% of spleen
- Grade V: shattered spleen; hilar injury
The case it is set beside is a 20-year-old obese male stabbed in the anterior abdomen, obese on examination, hemodynamically normal, with a stab in the abdomen and normal ABCDE - so the Grade is what the CT will return in a patient who has been kept stable long enough to have one.