Abdominal Trauma

1 General Perspectives on Abdominal Injury.- Incidence of Abdominal Injuries.- Variables Affecting Morbidity and Mortality.- General.- Age and Sex.- Condition of the Patient prior to the Trauma.- Multiple-System and Multiple Abdominal Organ Injury.- Condition of the Patient following Trauma.- 2 Types of Abdominal Injury.- Penetrating Injury.- Historic View and Changing Mortality Rate.- Etiology.- Age, Sex, and Race.- Stab Wounds.- Mortality.- Site of Injury.- The Selective Approach to Surgery.- Roentgenographic Evaluation by Stab-Wound Contrast Injection.- Gunshot Wounds.- The Weapon.- Wounding Potential.- Shotgun Injury.- Mandatory Surgical Intervention and Selectivity.- The Military Experience.- Blunt, Nonpenetrating Injuries.- Incidence and Mortality.- Multiple Injury.- Falls from Heights.- Seat-Belt Injuries.- 3 Specific Diagnostic Techniques.- History Taking.- General Considerations.- Medicolegal.- Subtle Injuries.- Delayed Manifestations of an Old Injury.- Physical Diagnosis.- The General Examination.- Examining Stab Wounds.- Examining Gunshot Wounds.- Examining the Patient Subjected to Blunt Trauma.- Laboratory Evaluation.- Hematocrits.- Leukocyte Count.- Serum Enzymes.- Serum Amylase.- Creatine Phosphokinase.- Glutamic Oxaloacetic Transaminase.- Lactic Dehydrogenase.- Alkaline Phosphatase.- Peritoneal-Fluid Enzymes.- Radiologic Evaluation.- Technique of the Radiographic Examination.- Chest Examination.- Abdominal Examination.- Plain-Film Evaluation.- Paracentesis and Peritoneal Lavage.- Technique.- Indications for Paracentesis and Peritoneal Lavage.- Interpretation of Results of Lavage.- Radionuclide Scanning.- History.- Technical Considerations.- Spleen.- Method.- Results.- Liver.- Methods.- Liver-Lung Scans.- Kidney.- Arteries.- Peritoneoscopy.- Indications.- Technique.- Illustrative Case Reports.- Exploratory Laparotomy.- The Incision.- Controlling Hemorrhage.- Inspection of Abdominal Organs.- Running the Bowel.- The Spleen, Pancreas, and Retroperitoneum.- 4 Specific Organ or Supporting-Structure Injury.- Diaphragm.- General Aspects of Injury.- Radiologic Features.- Spleen.- General Aspects of Injury.- Types of Splenic Injury.- Splenic Contusion with an Intact Capsule.- Capsular Tear with Oozing.- Splenic Laceration or Disruption with Hemorrhage.- Plain-Film Findings.- Alteration of Splenic Size, Position, and Contour.- Gastric Dilatation.- Serration of the Greater Curvature of the Stomach.- Sonographic Evaluation.- Contrast Evaluation.- Complications of Splenic Injury.- Delayed Splenic Rupture.- Pseudoaneurysm Formation.- Cyst Formation.- Splenosis.- Liver and Biliary Tract.- General Aspects of Injury.- Mechanism of Blunt Injury.- Sonography.- Radiologic Studies.- Associated Injuries to Supporting Structures.- Associated Intra- and Extraabdominal Injury.- Plain-Film Signs of Hepatic Injury.- Fluoroscopy.- Angiography.- Gallbladder.- Extrahepatic Biliary Ducts.- Intestinal Tract.- General Aspects of Injury.- Use of Contrast Agents for Diagnosis of Upper and Lower Gastrointestinal-Tract Traumatic Lesions.- Stomach.- Radiologic Diagnosis.- Duodenum.- Intramural Hematoma.- Retroperitoneal Perforation.- Intraperitoneal Perforation.- Small Bowel.- Intraperitoneal Perforation.- Colon and Rectum.- Mesenteric Laceration.- Intramural Hematoma.- Colonic Laceration.- Rectal Injury.- Mesenteric Injury.- Retroperitoneum.- Pancreas.- Mechanism of Injury.- Types of Injury.- Vascular System.- Total Transection.- Partial Transection and Pseudoaneurysm Formation.- Traumatic Arteriovenous Fistula.- Traumatic Dissection.- Genitourinary Tract.- Kidneys.- Diagnostic Evaluation.- Ureters.- Urinary Bladder.- Urethra.- Pelvic Fractures.- Classification and Mortality.- Associated Injuries and Mortality.- Exploratory Laparotomy.- Radiographic Diagnosis.- Angiographic Evaluation.