Ministry of Health

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 Published: 28/11/2011

Abdo Trauma

Injuries may be identified in the primary survey (breathing: diaphragmatic hernia, circulation: blood loss). Decisions for laparotomy may be based on history and exam findings or via the primary survey adjuncts (DPL or FAST scan).

At Auckland Hospital, DPL is performed as an open technique. (description)

A positive lavage comprises:
    1. Aspiration of >10mls of frank blood
    2. A red cell count in the lavage fluid of >100
    3. A white cell count of >5
    4. Any bile or vegetable material in the lavage fluid.
    5. Egress of lavage fluid via chest tube or urinary catheter.

DPL is steadily being replaced by a focused ultrasound assessment (FAST, focused assessment by sonography for trauma). The FAST scan should take between 1-5minutes and has the advantage that it is repeatable and non-invasive. The FAST operator should document the findings in the notes. When a credentialled operator is present, this investigation has acceptable sensitivity to exclude haemoperitoneum, cardiac tamponade and pleural fluid or blood.

The history of abdominal pain, may be all that points to significant intra abdominal injury. Signs may include the 'seat belt' sign, abrasion or bruising, and/or abdominal tenderness and/or gross haematuria. 
CT abdo may identify occult injuries in stable patients.
Patients with altered GCS or who are or will be intubated cannot be reliably assessed for these findings, or monitored for evolving peritonitis. Abdominal CT scan can be used to 'screen' these patients for occult injury.

Abdominal CT reports should include: organ injuries (or absence of), free fluid, air or contrast and fractures identified.

(see figure 3, appendix).

Last updated on 28/11/2011