Traumatisme Abdominal Quiz

Study Notes

Fréquence et Mortalité: Abdominal traumas are frequent with a high mortality rate (around 20%) mainly due to hemorrhage risk
Types of Trauma: The majority of abdominal traumas are closed injuries (without tearing the outer layer); contusions in solid organs (spleen, liver, kidneys, pancreas), perforations in hollow organs (duodenum, small intestine, colon), mesenteric and diaphragmatic tears are common. Penetrating traumas (e.g., stab wounds, gunshot wounds) or open injuries are increasing due to violence.
Epidemiological Factors: Contusion abdominal traumas are prominent (70% of spleen injuries, 60% of liver injuries) compared to penetrating injuries. The main cause of contusion are road accidents (70%).
Types of Contusion Causes: Road traffic accidents (70%), falls from height, sports/occupational accidents (crushing injuries), are common causes of contusions.
Patients Profile: Predominantly male patients (70%) in their thirties.
Penetrating Trauma: Penetrating traumas are mostly caused by knife or gun wounds in conflict or aggressive contexts.
Anatomical Landmarks: Abdominal limits include the lower ribs, diaphragm, spinal column (T12-L5), pelvis, and the abdominal wall muscles. The abdomen contains hollow and solid organs.

Mechanisms of Injury: Direct blows cause compressive and crushing injuries; lateral impacts are more harmful than frontal ones. High-velocity collisions lead to internal injuries. Airbags can mitigate some impact but not all damage. Seatbelts reduce intra-abdominal traumas.
Shear Injuries: Sudden decelerations during accidents induce shear forces, damaging the organs at their attachment points (vasculature, mesentery, ligamentum teres). These are most common in sudden deceleration injuries.
Damage from Weapons: The extent of injury with weapons (e.g., knives) depends on the weapon characteristics (length and width).
Compartment Syndrome: Increased intra-abdominal pressure from trauma can cause organ ischemia, reduced kidney function, and cerebral edema.

Clinical Examination: Vital signs (especially hemodynamic status for hemorrhage), history taking (for accident details, consciousness, witnesses, and mechanism), physical examination (look for impact marks, abdomen distension, pain, tenderness), and palpation (to find any signs of injury) are crucial.
Laboratory Tests: Complete blood count, blood typing, coagulation studies, and blood biochemistry (renal/liver/pancreatic) are usually performed.
Imaging: X-rays (especially chest) to evaluate other possible injuries, Ultrasound for FAST (focus assessment with sonography for trauma) for rapid screening for intraperitoneal bleeding, and CT scan for detailed internal visualization, are required.

Conservative Management: For patients with stable hemodynamic parameters, without gross evisceration, and no overt signs of peritonitis from penetrating traumas, conservative or non-operative management is the first choice.
Surgical Intervention: If hemodynamic instability persists, despite fluid resuscitation, a surgical approach (laparotomy) is often necessary to control hemorrhage and manage organ injuries.
Damage Control Surgery: When hemodynamic instability occurs with a trauma, a shorter surgical procedure (laparotomy) is prioritized to stop internal bleeding before treating any underlying organ damage.
Specific Treatments: Organs like the spleen, liver, pancreas, and hollow organs (intestines) require tailored operative approaches.
Post-operative care: Close monitoring, wound care, and supportive treatment.

American Association for the Surgery of Trauma (AAST) Classification: This system grades abdominal organ injuries based on the degree of the trauma (Grade I to VI). The AAST system helps determine severity and treatment approach.