Pathophysiology and management of abdominal injury

Abstract Abdominal injuries are common following blunt and penetrating trauma. They can result in a spectrum of severity from benign to potentially life-threatening conditions. Soon after injury, haemorrhage is the predominant concern, and leading cause of morbidity and mortality. Active haemorrhage resulting in shock requires emergent operative intervention and aggressive haemostatic resuscitation. However haemodynamically-stable patients benefit from non-operative management of solid organ injuries with or without angiographic embolization. Sepsis usually occurs as a result of intra-abdominal infections from missed bowel perforations or anastomotic leaks. Sterile systemic hyperinflammatory conditions can result from major hepatic necrosis or pancreatic injuries, and closely mimic infectious conditions. Damage control surgery is a valuable adjunct to the operative management of major abdominal trauma. This concept recognizes that the time and procedures required to perform definitive operative repair may be detrimental when physiological derangements are excessive. By limiting operations to controlling haemorrhage and enteric contamination, further deterioration, and the ‘vicious bloody cycle of trauma’ can be avoided. The operative and critical care management of patients with abdominal trauma should be closely integrated to correct physiological derangements with rapid stabilization and reversal of hypoperfusion. Abdominal compartment syndrome, characterized by intra-abdominal hypertension and resultant remote organ dysfunction, is a risk in patients undergoing high-volume fluid resuscitation. Emergent decompressive laparotomy is indicated in patients with abdominal compartment syndrome and results in rapid reversal of physiological compromise. Paramount to optimal management of abdominal injuries is the close integration of operative and critical care approaches.