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Abdominal trauma — blunt and penetrating
In abdominal trauma the decision is driven first by haemodynamic stability: an unstable patient with free fluid in the abdomen goes to theatre, and a stable patient has a CT, and most splenic and liver injuries in such patients are managed without surgery.
Why it matters in the exam
The exam builds its questions around one junction: is the patient stable? In an unstable patient with a positive FAST the answer is laparotomy, not CT; in a stable patient the answer is CT with intravenous contrast and treatment by the finding. For solid-organ injuries (spleen, liver) non-operative management is now the standard in a stable patient, even for high grades, provided there is close monitoring, access to angioembolisation and an available operating theatre.
Penetrating trauma is tested separately: a gunshot wound to the abdomen with peritoneal penetration usually requires laparotomy, while a stab wound in a stable patient without peritoneal signs can be managed by local wound exploration, imaging and serial examinations. Other questions cover the seat-belt sign, which raises suspicion of bowel and mesenteric injury and of a lumbar Chance fracture, pancreatic and duodenal injuries that early CT can miss, and vaccinations after splenectomy.
Key points
- Unstable with a positive FAST — laparotomy; stable — CT.
- Splenic and liver injuries in a stable patient — non-operative management, angioembolisation as needed.
- Gunshot wound penetrating the peritoneum — laparotomy in most cases; stab wound in a stable patient — selective assessment.
- Seat-belt sign — suspect bowel injury and a Chance fracture.
- After splenectomy — vaccinate against encapsulated bacteria.
Summary table
| Situation | Finding | Decision |
|---|---|---|
| Blunt trauma, unstable | Positive abdominal FAST | Urgent laparotomy |
| Blunt trauma, unstable, negative FAST | Look for another source: chest, pelvis, long bones, external bleeding | Pelvic binder; repeat FAST |
| Blunt trauma, stable | CT with intravenous contrast | Treat according to the finding |
| Splenic or liver injury, stable | Any grade, no peritonitis | Non-operative management with monitoring; angioembolisation when there is contrast extravasation |
| Gunshot wound to the abdomen | Peritoneal penetration | Laparotomy in most cases |
| Stab wound, stable, no peritoneal signs | Local wound exploration, CT and serial examinations | Surgery if peritoneal signs, shock or free air appear |
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Sources
- ATLS Advanced Trauma Life Support, Student Course Manual (American College of Surgeons), 10th edition (2018) — Abdominal and Pelvic Trauma
- WSES/AAST guidelines on splenic trauma and on liver trauma, 2017 and 2020 — Non-operative management and indications for surgery
- Sabiston Textbook of Surgery, 21st edition (2022) — Management of Acute Trauma
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.