Key messages

• 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.

• 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.

• High intra-abdominal pressure may decrease normal splanchnic blood flow, creating an 'abdominal compartment syndrome' with a low flow state to the bowels, leading to ischemia and necrosis, or possible reperfusion syndrome after reduction of intra-abdominal pressure.

• Pelvic fractures are complicated by severe hemorrhage and shock in up to 35 per cent of patients. The urethra is injured in 3 to 21 per cent of pelvic fracture in males, usually at the prostatic urethra.

• Severe tissue injury results in the systemic release of inflammatory mediators, which may cause an inflammatory reaction in remote organs, such as the lung, resulting in acute respiratory distress, systemic inflammatory response, and multiple organ failure.

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