Abdominal Injuries - In Depth About It!

Abdominal injury can be of various types; it may be confined to the abdomen or involve multiple systems. The severity and nature of abdominal injuries can vary widely, and thus generalizations cannot be made about the need for any type of surgery. The need for and the type of surgery depends a lot on the type of injury.
An injury may involve the abdominal wall, a number of solid abdominal organs such as spleen, liver, kidneys, pancreas, etc., hollow abdominal organs like stomach, colon, small intestine, bladder, ureters, etc., or it may involve the vasculature. 

Types of Abdominal Injuries-
Abdominal Injuries broadly divided into two categories:

1. Blunt Trauma-
Blunt trauma happens when there is a direct blow such as injuries that may happen on impact with something or result from a kick, fall from a height, etc. The spleen is the
most commonly damaged organ. After the spleen, it is the small intestine and the liver that is usually damaged.

2. Penetrating Injury-
In the case of penetrating injuries, stab wounds or gunshot wounds or some other wounds resulting from some accidents may result in organ damage. Any abdominal structure can be affected by such an injury. Even if such an injury happens in the lower chest, it may damage internal abdominal structures after crossing the diaphragm.
 

Complications Resulting from Abdominal Injury-
Consequences of abdominal injury may include intra-abdominal abscess, hematoma rupture, bowel obstruction, biliary leakage, abdominal compartment syndrome, bowel obstruction, delayed incisional hernia, etc. If there is a hematoma, it may resolve spontaneously or it may take several days and even months. However, if the hematoma is in the spleen or in the liver, the organs may rupture within the first few days of injury, giving rise to something known as a delayed hemorrhage. If the hematoma affects the intestinal wall, it may develop leaks, usually within 48 to 72 hours after the injury, which can release contents of the intestinal and cause a condition known as peritonitis. However, it may not cause much of a hemorrhage. It rarely causes intestinal stricture, that may happen years later.

There may be a formation of Intra-abdominal abscess as a result of perforation of hollow viscus organs like small intestine, colon, etc., going undetected after the accident or as a complication of laparotomy. Bowel obstruction may develop in a few weeks or it may take years to develop, but it is common after abdominal injuries. It may also happen as a side effect of adhesions caused by exploratory laparotomy. Bile leakage can be caused by injury to the liver or the bile duct. In case of an injury, bile may spread throughout the peritoneal cavity or cause a distinct abscess often referred to as Biloma. It is a painful condition and may have a number of other repercussions.

The person may also suffer from abdominal compartment syndrome causing pain and organ dysfunction that may affect organs like:
● Kidneys and cause renal problems
● Lungs and result in difficulty breathing and hypoxemia
● Cardiovascular system and result in hypotension
● Central Nervous System and cause an intracranial pressure increase
 

Take Away-
Patients of abdominal injury experiencing a sudden worsening of pain within a few days of the injury may have a ruptured solid organ causing hematoma or a delayed perforation in hollow viscous organs. If the pain is worsening steadily within the first days, there may be hollow viscus perforation and if the same happens after several days, there may be abscess formation. In all these cases, surgery is the way to go after a good imaging study with CT. However, it is always advisable to consult the doctor before opting any type of treatment or surgery.