Trauma is the leading cause of death among young people in the West. Over 150 000 deaths due to trauma occur annually in the United States, and abdominal injuries account for a small but significant number of these. Unrecognized abdominal injuries are a frequent cause of death, which often occurs in the intensive care unit (ICU). Peritoneal signs are often subtle, and are underestimated because of pain from associated extra-abdominal trauma or masked by head injury or intoxicants. Moreover, the peritoneal cavity is a potential reservoir for major occult blood loss, resulting in late therapy. The primary factor in assessing and managing abdominal trauma is not the accurate diagnosis of a specific type of abdominal injury, but rather recognizing that an intra-abdominal injury exists and that operative intervention is required (Romenofsky,,efa/ 1993).

A flowchart for the management of abdominal injury is shown in Fig 1.

Fig. 1 Flowchart for management of abdominal injury: DPL, diagnostic peritoneal lavage. Note that there are exceptions to each category.

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