• 25% of all trauma victims require “abdominal exploration” -Exploratory laparotomy cause of the problem is found during the procedure, then treatment is often done at the same time
  • P/Exam: inadequate to identify intra-abdominal injuries
  • Diagnostic modalities- CXR, FAST, DPL, CT & laparoscopy

Blunt trauma: Z

  • Hemodynamically stable- FAST , CT scan
  • Hemodynamically unstable- FAST

Diagnostic peritoneal lavage (DPL)

  • Insert catheter below umbilicus under LA. - if Bloody aspirate- laparotomy.
  • 1L NS infusion into peritoneum.
  • Returning fluid is bloody- positive lavage.
  • Rapid and safe
  • Do not determine origin of blood
  • Too sensitive
  • Does not evaluate retroperitoneal injury
  • Replaced by FAST and CT scan

(Image: Diagnostic peritoneal lavage (DPL))

FAST- Focused abdominal sonography in trauma

  • Rapid & accurate.

  • Sensitivity up to 99%.

  • Detects small amount (100 ml) of blood.

  • Four views:

    1. Pericardiac
    2. Perihepatic
    3. Perisplenic
    4. Pelvic
  • Helpful in management of unstable patients.

(Image: FAST)

Penetrating Abdominal injuries

  • Gun shot injuries: urgent surgery
  • Stab (knife) injury: * A: Hemodynamically stable- wound exploration, CT scan, Surgery only if intra-abdominal injuries found * B: Hemodynamically unstable- surgery