Blunt Abdominal Trauma Guidelines

Updated: Mar 30, 2022
  • Author: Eric L Legome, MD; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Guidelines

Guidelines Summary

WSES guidelines

The World Society of Emergency Surgery (WSES) has published guidelines on bowel trauma diagnosis and management. Highlights of the guidelines on blunt bowel injury include the following [53] :

  • Management of the awake and oriented patient with blunt abdominal trauma starts with the primary survey, E-FAST, physical examination, secondary survey, blood chemistry, vital signs, and contrast-enhanced abdominal CT.
  • The presence of a seatbelt sign should prompt a CT scan and a high index of suspicion for bowel injury.
  • In selected cases, repeat CT might be considered. Patients with equivocal signs on initial CT scan should be reimaged after 6 hours. In patients who demonstrate evolving clinical signs suspicious for bowel injury, reimaging should be considered.
  • The presence of highly specific CT findings such as extraluminal air, extraluminal oral contrast, or bowel-wall defects warrants prompt surgical exploration.
  • The presence of highly sensitive CT findings such as free fluid in the absence of solid-organ injury, abnormal enhancement of bowel wall, and mesenteric stranding can be used as an adjunct to the clinical picture but should not solely determine management.