Management of Penetrating Abdominal Trauma in the Emergency Department
Abstract
Background: Penetrating abdominal trauma is a critical, high-stakes emergency and a leading cause of trauma-related mortality, particularly among young males in urban settings. It involves a breach of the abdominal wall by objects such as knives or bullets, posing immediate risks of life-threatening hemorrhage and hollow viscus perforation.
Aim: This article synthesizes the current principles for managing penetrating abdominal trauma in the emergency department, focusing on rapid triage, accurate evaluation, and decisive intervention to control hemorrhage and contamination, thereby reducing preventable deaths.
Methods: The review outlines a protocol-driven approach based on Advanced Trauma Life Support (ATLS) principles. Key diagnostic methods include the Focused Assessment with Sonography for Trauma (FAST) for unstable patients and computed tomography (CT) with intravenous contrast for stable patients to identify injury tracts and organ damage. Management pathways are stratified by patient physiology.
Results: Hemodynamically unstable patients require immediate surgical exploration. For stable patients, Selective Non-Operative Management (SNOM) is increasingly viable, supported by serial examinations and imaging. Minimally invasive techniques like laparoscopy and endovascular interventions (e.g., REBOA, angioembolization) have expanded treatment options, reduced the rate of non-therapeutic laparotomies and improving outcomes.
Conclusion: Successful management hinges on a disciplined, algorithm-based approach that integrates rapid assessment, judicious use of imaging, and a spectrum of interventions from observation to damage-control surgery. This systematic strategy is essential for optimizing survival and minimizing complications.
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