Introduction

Patients with abdominal trauma can present with a wide variety of clinical signs and symptoms. Initial investigation can be misleading, and injury is only suspected in a later phase when clinical signs occur. Medical attention may be misdirected to other more obvious injuries of the head, spine, thorax, or extremities. Delay in establishing the correct diagnosis and treatment may lead to increased morbidity and mortality. Injury to the abdomen can be divided into the following groups:

1. interrupted tissue continuity (wounds, fractures, parenchymal injury);

2. perforation and leakage of intestines;

3. hemorrhage from vessel rupture or parenchymal injury;

4. necrosis and ischemia;

5. lesions resulting from the propagation of high pressures through tissues (i.e. ruptured diaphragm with pelvic compression injury).

Knowledge of underlying pathophysiological processes is required to understand the events taking place after abdominal trauma and to prevent later sequelae. Trauma mechanism

In the early phase after injury, the pathophysiology of blunt and penetrating injury may be very different. Stab wounds lead to a well-defined limited injury. Bullets produce more extensive tissue damage, depending on the type and kinetic energy of the missile (high versus low velocity). Gunshot wounds produce more hollow viscus injury and subsequent infectious complications than stab wounds. This is due to the mechanism of stabbing; victims are usually stabbed in the anterior abdominal wall.

Predicting the trajectory of a bullet or a knife wound after the skin has been entered is difficult; the line of damage may follow a ricochet pathway or it can be altered due to postural changes.

Blunt injury usually results in more widespread damage, even at some distance from the point of impact; essentially, there are crush lesions and lesions due to sudden high pressure. Both blunt and penetrating trauma may lead to hemorrhage, tissue necrosis, and organ damage. Late complications of the two types of injury are similar.

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