Imaging in abdominal trauma

Around the world trauma is still one of the commonest causes of death in the first four decades of life. Approximately 15% of all trauma patients will have an abdominal injury. Most abdominal injuries are treatable, but early recognition is essential to reducing the morbidity and mortality of such patients. The severely injured patient can have multiple intra-abdominal pathologies, but recognition of these injuries can be difficult. A large prospective observational study of patients with blunt polytrauma showing no clinical signs of injury found radiological evidence of abdominal injury in almost 10% of patients.

Abdominal trauma is generally categorised by its mechanism. Blunt trauma is the most common type. Motor vehicle accidents (MVA) account for around 75% of such injuries. Blunt trauma has a greater mortality due to its effects of compression and deceleration on the whole abdomen, with liver and spleen most commonly injured. Penetrating trauma is less common, the majority tending to involve gunshot or stab wounds. Knowing the trajectory of the penetrating wound helps with assessment of possible internal injuries. Liver, stomach and small bowel are the most commonly injured organs in penetrating trauma. While clinical examination can be helpful in predicting abdominal injuries in blunt or penetrating trauma, ultimately imaging is usually required to fully assess the patient.

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