Penetrating Abdominal Trauma Differential Diagnoses

  • Author: Patrick Offner, MD, MPH; Chief Editor: John Geibel, MD, DSc, MA   more...
 
Updated: Jan 23, 2012
 
 

Diagnostic Considerations

Problems to be considered in patients with penetrating abdominal trauma include the following:

  • Coagulopathy
  • Comorbid medical conditions
  • Concomitant closed head injury
  • Concomitant penetrating chest injury

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Patrick Offner, MD, MPH  Chief, Surgical Critical Care, Department of Surgery, Trauma Services, St Anthony Central Hospital

Patrick Offner, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, Colorado Medical Society, and Western Surgical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Katie Jo Stanton-Maxey, MD  Assistant Professor, Department of Surgery, Indiana University School of Medicine

Katie Jo Stanton-Maxey, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

H Scott Bjerke, MD, FACS  Clinical Associate Professor, Department of Surgery, University of Missouri-Kansas City School of Medicine; Medical Director of Trauma Services, Research Medical Center; Clinical Professor, Department of Surgery, Kansas City University of Medicine and Biosciences

H Scott Bjerke, MD, FACS is a member of the following medical societies: American Association for the History of Medicine, American Association for the Surgery of Trauma, American College of Surgeons, Association for Academic Surgery, Eastern Association for the Surgery of Trauma, Midwest Surgical Association, National Association of EMS Physicians, Pan-Pacific Surgical Association, Royal Society of Medicine, Southwestern Surgical Congress, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA  Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director, Surgical Research, Department of Surgery, Yale-New Haven Hospital

John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract

Disclosure: AMGEN Royalty Consulting; ARdelyx Ownership interest Board membership

Additional Contributors

Roy Alson, MD, PhD, FACEP, FAAEM Associate Professor, Department of Emergency Medicine, Wake Forest University School of Medicine; Medical Director, Forsyth County EMS; Deputy Medical Advisor, North Carolina Office of EMS; Associate Medical Director, North Carolina Baptist AirCare

Roy Alson, MD, PhD, FACEP, FAAEM is a member of the following medical societies: Air Medical Physician Association, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, National Association of EMS Physicians, North Carolina Medical Society, Society for Academic Emergency Medicine, and World Association for Disaster and Emergency Medicine

Disclosure: Nothing to disclose.

Alfred B Cheng, MD Staff Physician, Department of Emergency Medicine, New York University, Bellevue Medical Center

Disclosure: Nothing to disclose.

Ernest Dunn, MD Program Director, Surgery Residency, Department of Surgery, Methodist Health System, Dallas

Ernest Dunn, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, Association for Academic Surgery, Society of Critical Care Medicine, and Texas Medical Association

Disclosure: Nothing to disclose.

Jon Mark Hirshon, MD, MPH Associate Professor, Department of Emergency Medicine, University of Maryland School of Medicine

Jon Mark Hirshon, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Public Health Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Lewis J Kaplan, MD, FACS, FCCM, FCCP Director, SICU and Surgical Critical Care Fellowship, Associate Professor, Department of Surgery, Section of Trauma, Surgical Critical Care, and Surgical Emergencies, Yale University School of Medicine

Lewis J Kaplan, MD, FACS, FCCM, FCCP is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, Association for Academic Surgery, Association for Surgical Education, Connecticut State Medical Society, Eastern Association for the Surgery of Trauma, International Trauma Anesthesia and Critical Care Society, Society for the Advancement of Blood Management, Society of Critical Care Medicine, and Surgical Infection Society

Disclosure: Nothing to disclose.

Eric L Legome, MD Chief, Department of Emergency Medicine, Kings County Hospital Center; Associate Professor, Department of Emergency Medicine, New York Medical College

Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Robert L Sheridan, MD Assistant Chief of Staff, Chief of Burn Surgery, Shriners Burns Hospital; Associate Professor of Surgery, Department of Surgery, Division of Trauma and Burns, Massachusetts General Hospital and Harvard Medical School

Robert L Sheridan, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, and American College of Surgeons

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Paul A Testa, MD, JD, MPH Attending Physician, Department of Emergency Medicine, New York University School of Medicine

Paul A Testa, MD, JD, MPH is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians

Disclosure: Nothing to disclose.

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Management of penetrating abdominal trauma. CT = computed tomography; DPL = diagnostic peritoneal lavage; RBC = red blood cells.
Penetrating abdominal trauma. Tangential gunshot wound to the liver.
Penetrating abdominal trauma. Strangulated small bowel in a patient with a previous gunshot wound to the abdomen.
Note that the resident is carefully maintaining the position of the impaled stop sign post, so as not to dislodge the shaft. The shaft was removed in the OR along with the patient's right colon.
This is an operative photograph of an extremely rare injury: a midureteral transection from a gunshot wound. The patient was shot with a MAC-10 machine gun and sustained liver injury as well as injuries to the duodenum, colon, terminal ileum, sigmoid colon, rectum, gallbladder, bladder, and left femur. He underwent a damage control operation and survived his injuries after 3 subsequent operations.
This liver injury was sustained by the patient shot with a MAC-10 machine gun. The injury has been opened to control bleeding branches of the portal and hepatic veins as well as the hepatic arterial radicles. Several biliary ducts were ligated, and the back wall of the gallbladder can be identified in the depths of the wound. A cholecystectomy was required for management of the wound.
The patient's small intestine clearly protrudes through his anterior abdominal wall following a stab wound caused by a machete. The operative repair and recovery were uneventful.
A standard diagnostic peritoneal lavage (DPL) catheter is secured in place following an open DPL. An aspirating syringe is attached to the catheter via extension tubing as the initial step in the evaluation for intraperitoneal blood.
An ED thoracotomy has been performed, and the aorta is cross-clamped. Note the proper positioning of the ratchet mechanism of the rib spreader to allow extension of the incision to the right chest for a clamshell thoracotomy if needed. This patient arrived with a weak pulse and a systolic blood pressure of 40 mm Hg and promptly died on the ED stretcher. An ED thoracotomy was performed for cardiopulmonary-cerebral resuscitation.
This 22-year-old woman sustained a gunshot wound to the left flank. At exploration, she had a through-and-through laceration of her spleen. The bleeding was arrested by finger compression of the splenic hilum while it was mobilized. A splenectomy was performed because the bullet went through the hilum.
A 34-year-old man flipped over the handlebars of his motorcycle and landed on a wrought-iron fence. His helmet was knocked off when he landed. The medics cut the fence apart and transported the patient and fence to the ED (see image). On presentation, the patient's vital signs are as follows: rectal temperature, 95.3°F; heart rate, 126 beats per minute; respiration rate, 24 (labored); and blood pressure, 94/62 in his left arm. Intubation, bilateral upper extremity intravenous access, 2000 mL intravenous fluid, AP CXR, and operation is the correct sequence in which to resuscitate the patient to address the ABCs.
 
 
 
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