**5. Types of injuries**

The distribution of blunt and penetrating injury in a given population is highly dependent upon geographic location. Blunt injuries predominate in rural areas, while penetrating injuries are more common in urban areas. The specific type of injury varies according to whether the trauma is penetrating or blunt. The mechanism of injury in blunt trauma is rapid deceleration, and noncompliant organs such as the liver, spleen, pancreas, and kidneys are at greater risk of injury due to parenchymal fracture.

There are two basic physical mechanisms at play with the potential of injury to intra-abdominal organs: compression and deceleration. The former occurs from a direct blow, such as a punch, or compression against a non-yielding object such as a seatbelt or steering column. This force may deform a hollow organ, thereby increasing its intraluminal or internal pressure, leading to rupture [15]. Deceleration, on the other hand, causes stretching and shearing at the points at which mobile structures, such as the bowel, are anchored. This can cause tearing of the mesentery of the bowel, and injury to the blood vessels that travel within the mesentery. Classic examples of these mechanisms are a hepatic tear along the ligamentum

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When blunt abdominal trauma is complicated by "internal injury," the liver and spleen are

In rare cases, this injury has been attributed to medical techniques such as the Heimlich maneuver, attempts at cardiopulmonary resuscitation and manual thrusts to clear an airway. Although these are rare examples, it has been suggested that they are caused by applying unnecessary pressure when administering such techniques. Finally, the occurrence of splenic rupture with mild blunt abdominal trauma in those convalescing from infectious mononucle-

A major addition in management of blunt trauma has been the focused assessment with sonography for trauma (FAST) examination. Ultrasound has proved to be an ideal modality in the immediate evaluation of the trauma patient because it is rapid and accurate for the

The goal of the FAST examination is the identification of abnormal collections of blood or fluid. In this regard, it obviates the need for diagnostic peritoneal cavity, but attention is

Numerous methods for the definitive control of hepatic hemorrhage have been developed. Minor lacerations may be controlled by direct compression to the injury site. For similar injuries which do not respond to compression, topical hemostatic techniques have been successful. Small bleeding vessels may be controlled electrocautery. Microcrystalline collagen can be used. The powder is placed on a clean sponge and applied directly to the site. Pressure is maintained for 5–10 min. Fibrin glue has been used for both superficial and deep lacerations

Suturing of the hepatic parenchyma remains an effective hemostatic technique. Although this treatment has been maligned as a cause of hepatic necrosis, hepatic sutures are often used for persistently bleeding lacerations less than 3 cm in depth. It is also an appropriate alternative for deeper lacerations if the patient will not tolerate further hemorrhage. The preferred suture is 2–0 or 0 chromic attached to a large and curved blunt needle. The large diameter of the

teres and injuries to the renal arteries [16].

osis is well reported.

**6. Specific organ injuries**

**6.1. Liver injuries**

most frequently involved, followed by the small intestine [17].

detection of intra-abdominal fluid or blood and is readily repeatable.

directed also to the pericardium and to the pleural space.

and appears to be an effective topical agent [18].

suture helps prevent it from pulling through Glisson's capsule [19].

Deaths from abdominal trauma result principally from hemorrhage or sepsis. Most deaths from abdominal trauma are preventable. Patients at risk of abdominal injury should undergo prompt and thorough evaluation. In some cases, dramatic physical findings may be due to abdominal wall injury in the absence of intraperitoneal injury. If the results of diagnostic studies are equivocal, diagnostic laparoscopy or exploratory laparotomy should be considered, since they may be lifesaving if serious injuries are identified early.
