36. Trauma-associated abdominal injuries

Question 1

36. Trauma-associated abdominal injuries

Answer 1

Abdominal trauma
-surgery indicated in case:
>evidence of septic peritonitis
>any form of penetrating injury
>evidence of unremitting intraperitoneal hemorrhage
>any evidence of a traumatic body wall hernia that contains herniated
abdominal viscera
-in all cases,thorough exploratory laparotomy necessary
-decision to operate:after stabilization/deteriorating patient

Trauma-associated urinary tract injury
-blunt/penetrating
-trauma to the urinary tract often goes undetected
(initially)
-uroperitoneum
-retroperitoneal injuries(kidney, ureter)
-bladder injuries(rupture)
-urethral injuries(rupture)

Uroperitoneum
-uroperitoneum–urine in the peritoneal cavity
-occurs secondary to urine leakage from the urethra,bladder,ureter
or kidney
-diagnosis:anamnesis,examination,hematology,biochemistry,ECG,abdominocentesis+fluid analysis,diagnostic imaging
-treatment:stabilization(life-threatening hyperkalemia!,abdominal
drainage),definitive treatment variable,surgery often necessary

Excretory urography

Trauma-associated abdominal parenchymal
organ injury
-common,hemorrhage the most common complication(injury to the
liver,spleen,kidneys)
-diagnosis:examination,imaging,bloodwork,monitoring(BP, ECG),abdominocentesis
-most animals with blunt abdominal parenchymal organ injury and
hemoabdomen can be managed conservatively whilst others may
require emergent surgery
-following cardiovascular stabilization,animals with penetrating abdominal injury require immediate surgery(potential bowel
perforation etc.)

Trauma-associated biliary tract injury
-traumatic injury to the extra-hepatic biliary tract uncommon in dogs
and rare in cats
-difficult to diagnose
-challenging to treat successfully
-spillage of bile can lead to generalized peritonitis
-diagnosis:blood sample,imaging,abdominocentesis+fluid analysis,exploratory laparotomy
-treatment:surgical(treatment of defect,peritoneal lavage,ongoing drainage)

Trauma-associated body wall and torso injury
-abdominal wall herniation-a protrusion of the abdominal contents through an acquired/congenital area of weakness or defect in the wall
-can occur at multiple sites
-diagnosis:physical examination,diagnostic imaging
-treatment:surgical once the patient is stable
-in case of strangulation–emergency surgery
-evisceration–extrusion of viscera outside the body through a wound
or a surgical incision
-treatment:protection of organs(contamination),stabilization,bacterial culture,AB,surgical closure(thorough lavage;drain?)

Abdominal wall herniation

Hernia and evisceration

Trauma-associated gastrointestinal injury
-primary gastrointestinal injuries can include:
>minor bowel contusions/hematomas
>mesenteric tears
>vascular compromise/avulsion
>penetrating wounds resulting in septic peritonitis
-diagnosis:clinical examination,imaging(contrast radiography iodine
not barium if suspected perforation!),abdominocentesis(in case of
ascites)+fluid analysis,bloodwork
-treatment: surgery often indicated

Contrast radiography