ABDOMINAL TRAUMA.pptx in clinical surgery

Abdominal trauma in clinical surgery

1. ABDOMINAL TRAUMA GROUP NO.5 1

2. GROUP MEMBERS KOMBO SHAMTE KOMBO FIRDAUS HASSAN SULEIMAN IBRAHIM SAID OMAR RANIA HUSSAM ABDALLA SABBAH YAHYA MOHAMED MUNAWWAR KHAMIS JUMA MWANAMKASI HAJI RAJAB MOHAMMED MASOUD MOHAMMED MD/10/22/005/TZ MD/10/22/008/TZ MD/10/22/028/TZ MD/10/22/037/TZ MD/10/22/045/TZ MD/10/22/048/TZ MD/10/22/059/TZ MD/10/22/061/TZ 2

3. OBJECTIVES Introduction of abdominal trauma Epidemiology of abdominal trauma Causes of abdominal trauma Common organs injured in blunt and penetrating abdominal trauma Diagnostic imaging modalities used in abdominal trauma with their advantages and disadvantages The best imaging modalities in blunt and penetrating abdominal trauma Radiological findings in blunt and penetrating abdominal trauma I maging examples 3

4. Introduction of abdominal trauma Abdominal trauma is an injury to the abdominal area, potentially causing damage to organs and other structures within. Abdominal trauma is categorized as either blunt or penetrating.  Blunt trauma involves direct impact on abdominal area ( eg , kick), impact with an object ( eg , fall on bicycle handlebars), or sudden deceleration ( eg , fall from a height, vehicle crash ) often resulting in injuries to the spleen, liver, or other solid organs.  Penetrating trauma involves a sharp object entering the abdominal cavity, potentially damaging any structure within .  4

5. Epidemiology of abdominal trauma Abdominal trauma is a significant public health concern in Tanzania, contributing to high morbidity and mortality rates. Road traffic accidents are the most common cause of blunt abdominal injuries, while penetrating injuries are often due to violence, including armed robbery and criminal activities. Abdominal trauma tends to affect males more frequently than females.  The age group most affected by abdominal trauma is typically between 21 and 40 years old.  5

6. Causes of abdominal trauma Common causes of blunt abdominal trauma:  Motor vehicle crashes, falls, sports injuries, and assaults.  Common causes of penetrating abdominal trauma:  Stab wounds, gunshot wounds.  6

7. Common organs injured in blunt and penetrating abdominal trauma Blunt abdominal trauma Most common injuries :  Spleen and liver. Other solid organs :  Pancreas, kidneys Hollow viscus injuries :  Small bowel, large bowel, stomach. Diaphragm and retroperitoneal structures :  Can also be injured.  7

8. Penetrating abdominal trauma Most common injuries:  Small bowel, large bowel, liver, and abdominal vasculature. Other organs:  Stomach, pancreas, kidney , spleen 8

9. Diagnostic imaging modalities used in abdominal trauma with their advantages and disadvantages Focused Assessment with Sonography in Trauma (FAST scan) A rapid bedside ultrasound exam focused on detecting free fluid (usually blood) in the peritoneal, pericardial, and pleural spaces . The key areas examined are morison’s pouch, splenorenal recess, pouch of Douglas . This is the first-line imaging in hemodynamically unstable patients and is used in the emergency room or trauma bay for quick assessment . 9

10. Advantages Non-invasive and quick (2–5 minutes). No radiation. Performed at bedside. Limitations Operator-dependent. May miss injuries without free fluid. Less sensitive for bowel or retroperitoneal injuries . 10

11. Computed Tomography (CT) scan with contrast A cross-sectional imaging technique using X-rays and computer processing to produce detailed images of abdominal structures, usually enhanced with intravenous (and sometimes oral) contrast . It is used in hemodynamically stable patients and when detailed organ injury assessment is needed . 11

12. Advantages High-resolution, detailed images. Detects solid organ injury, active bleeding, bowel and mesenteric injuries, pneumoperitoneum, and retroperitoneal trauma. Can guide surgical decisions or conservative management. Limitations Requires patient to be stable. Exposure to ionizing radiation. Risk of contrast-induced nephropathy or allergic reactions . 12

13. X-ray Often used to evaluate associated injuries (e.g., rib fractures, pneumoperitoneum, foreign bodies ). Advantages Quick and available. Useful in detecting free air under the diaphragm (suggests bowel perforation). Limitations Has low sensitivity and specificity in abdominal trauma. Poor soft tissue detail . 13

14. Magnetic Resonance Imaging (MRI) Uses magnetic fields and radio waves to produce detailed images . It is rare in acute trauma settings due to time and availability. It may be used later for soft tissue or spinal cord injury assessment, or in children/pregnant patients where radiation should be avoided . 14

15. Advantages Excellent soft tissue detail. No radiation. Limitations Time-consuming. Not ideal for unstable or unconscious patients. Expensive and less available. 15

16. The best imaging modality in abdominal trauma In cases of abdominal trauma, the best radiological modality is a computed tomography (CT) scan of the abdomen and pelvis with intravenous contrast. This is because CT scans are highly sensitive and specific for detecting injuries in solid organ, bowel or bony injury and may identify the site of significant active bleeding. 16

17. The high resolution of CT images allows for clear visualization of organ lacerations, hematomas, and vascular injuries which are common in abdominal trauma cases. While ultrasound may serve as a preliminary assessment tool in specific scenarios (such as FAST exams),  CT scan remains the gold standard for evaluating blunt and penetrating abdominal trauma due to its speed, accuracy, and detailed imaging capabilities . 17

18. Radiological findings in blunt and penetrating abdominal trauma In CT scan Hemoperitoneum : Collection of blood in the peritoneal cavity, appearing as fluid with varying attenuation depending on clotted or fresh blood.  Lacerations: Linear or branching hypodense (dark) areas representing tissue damage, often in the spleen and liver.  Hematomas: Oval or round areas of blood accumulation, either subcapsular (under the capsule of the organ) or within the organ.  18

19. Contusions: Ill-defined areas of non-enhancing hypodensity , representing bruised tissue.  Vascular Injuries: Extravasation of contrast (high density on CT) indicating bleeding from damaged vessels, including the liver, IVC, and portal veins.  Diaphragm Rupture: A diaphragm tear may be visualized, potentially with herniation of abdominal contents into the chest.  19

20. Organomegaly : Enlarged organs, particularly the spleen or liver, may suggest trauma and potential bleeding.  Pneumoperitoneum : Often a strong indicator of bowel perforation, requiring immediate surgical intervention.  Bowel Injury: Focal wall thickening, discontinuity, or mesenteric infiltration may suggest bowel damage, particularly near the site of entry.  20

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23. 23 Splenic injury : The findings are following Linear hypodense areas consistent with lacerations. Round and oval hypodense areas consistent with intrasplenic hematoma. Hemoperitoneum .

24. Haemoperitoneum from splenic injury . Computed tomography scan showed massive haemoperitoneum (arrows) due to laceration at splenic hilum 24

25. 25 Active haemorrhage from splenic injury seen as contrast extravasation (arrow).

26. 26 The findings are the following : Hemoperitoneum around the spleen and the liver. Linear hypodense area in the anterior part of the spleen consistent with laceration. Medially of the spleen is a deposit of contrast consistent with extravasation.

27. 27 The findings are: Green arrow: oval shaped hypodense area consistent with hematoma Yellow arrow: linear shaped hypodense area consistent with laceration. Notice that this laceration crosses the left portal vein. Blue arrow: vague ill defined hypodense area consistent with contusion Fluid around the liver There is almost a transsection of the liver , but both lobes do enhance so there is still normal vascular supply.

28. 28 The patient with a knife stab injury in the right flank The CT demonstrates nicely, that the injury is limited to the retroperitoneal space with a small renal hematoma.

29. 29 This is a typical left sided package injury. There is pancreatic tail injury and also splenic injury, renal injury and pneumoperitoneum.

30. 30 'Dependent viscera' sign in left-sided diaphragmatic rupture On the left side there clearly is a diaphragmatic rupture with herniation of the stomach. Notice that the stomach and the spleen lie against the posterior thoracic wall, which is abnormal. This is unlike on the right side where the liver is away from the chest wall due to the presence of the diaphragm .

31. 31 Hypoperfusion of the spleen (yellow arrow). Multiple areas of contrast extravasation (green arrows). Hemoperitoneum and Pneumoperitoneum. Multiple segments of bowel with diffuse wall thickening (blue arrow ).

32. In FAST ultrasound Hemoperitoneum : Free fluid in the peritoneal cavity, appearing anechoic (black) on ultrasound, is a significant finding. 32 FAST ultrasound probe positions

33. 33 In these ultrasound images obtained in the right upper quadrant, free fluid in the abdomen is visible as a black (anechoic) collection separating the liver and the right kidney in Morison’s pouch

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35. In x-ray Pneumoperitoneum: The presence of free air in the peritoneal cavity, often seen as a crescent-shaped area under the diaphragm on an upright chest X-ray, is a significant finding indicating bowel perforation.  Pneumothorax and Hemothorax : These findings, indicating air and/or blood in the chest cavity, are common in blunt trauma cases, especially those involving the chest.  35

36. Fractures: X-rays can reveal fractures of the ribs, spine, or pelvis, which may indicate the force of impact and the potential for associated abdominal injuries.  Retained projectiles : X-rays can identify the location and number of retained projectiles, such as bullets, from penetrating injuries.  Bowel wall defect : A discontinuity in the bowel wall can be visualized on X-ray, indicating a perforation or injury.  36

37. 37 Metal spear has entered the child's right chest and continued though the diaphragm and abdomen, exiting the left lateral abdomen. Large right pneumothorax with mediastinal shift to the left and herniation of right lung across the midline .

38. 38 Lateral projection (with horizontal beam) confirms the abdomen is involved and there is a small amount of free gas beneath the diaphragm and anterior abdominal wall, indicating perforation of a hollow viscus (not shown).

39. References Davis JJ, Cohn I Jr, Nance FC. Diagnosis and management of blunt abdominal trauma. Ann Surg 1976; 183:672 . Hassan R, Abd Aziz A, Md Ralib AR, Saat A. Computed tomography of blunt spleen injury: a pictorial review. Malays J Med Sci. 2011 Jan;18(1):60-7. PMID: 22135575; PMCID: PMC3216201 . Marietta M, Burns B. Penetrating Abdominal Trauma. [Updated 2025 Feb 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan- . Ntundu , S.H., Herman, A.M., Kishe , A.  et al.  Patterns and outcomes of patients with abdominal trauma on operative management from northern Tanzania: a prospective single centre observational study.  BMC Surg   19 , 69 (2019). https:// doi.org/10.1186/s12893-019-0530-8 Radiology Assistant app 2.0 (2023) Stassen NA et al. "The role of computed tomography in blunt abdominal trauma."  Journal of Trauma  2019; 87(4): 1000-1007 . Strahan R, Pediatric penetrating thoraco -abdominal trauma. Case study, Radiopaedia.org (Accessed on 27 Apr 2025) https://doi.org/10.53347/rID-51450 39

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