Abdominal trauma – colloquially called abdominal trauma – (synonyms: Abdominal injury; Internal abdominal injury; Blunt abdominal trauma; Perforating abdominal trauma; Perforating abdominal trauma; ICD-10-GM S30-S39: Injuries to the abdomen, lumbosacral region, lumbar spine, and pelvis) refers to injury (trauma) to the abdominal cavity (abdomen) or organs in the abdomen caused by mechanical force. In patients with polytrauma (multiple injuries), abdominal trauma is present in 20% to 40% of cases. In polytrauma children, blunt abdominal trauma is present in about one-third. According to the ICD-10-GM 2019, abdominal trauma (abdominal trauma) is classified as follows, depending on the type of injury:
- Superficial injury to the abdomen, lumbosacral region (junction between the lumbar spine and sacrum), and pelvis – S30.-.
- Open wound of the abdomen, lumbosacral region, and pelvis – S31.-
- Fracture of the lumbar spine and pelvis – S32.-.
- Dislocation, sprain and strain of joints and ligaments of the lumbar spine and pelvis – S33.-
- Injury to the nerves and lumbar (“affecting the lumbar vertebrae”) spinal cord at the level of the abdomen, lumbosacral region and pelvis – S34.-.
- Injury to blood vessels at the level of the abdomen, lumbosacral region, and pelvis – S35.-
- Injury to intra-abdominal (located in the abdominal cavity) organs – S36.-.
- Injury to urinary organs and pelvic organs – S37.-.
- Crushing and traumatic amputation of parts of the abdomen, lumbosacral region and pelvis – S38.-.
- Other and unspecified injuries of the abdomen, lumbosacral region and pelvis – S39.-.
Furthermore, abdominal trauma can be differentiated by cause:
- Blunt abdominal trauma – the abdominal wall is intact, possibly bruise marks (v.a. hematoma/bruise, abrasion); e.g. due to a rear-end collision, impact against the steering wheel, bump, blow (traffic or work accidents, etc.); common.
- Perforating abdominal trauma – due to stabbing, gunshot, or impalement injuries; rare.
Abdominal trauma may involve injuries to the diaphragm, stomach, duodenum (small intestine), small intestine, colon (large intestine), gallbladder, pancreas (pancreas), liver, spleen, mesentery (mesentery/doubling of the peritoneum, originating from the posterior abdominal wall), kidney, and urinary bladder. In blunt trauma, the spleen is most commonly involved, followed by kidneys, organs of the gastrointestinal tract (digestive tract), urinary bladder, as well as diaphragm. Perforating trauma usually involves injuries to the small intestine, but also to the mesentery, liver, and colon (large intestine). Sex ratio: boys are affected by blunt abdominal trauma approximately three times more often than girls. Frequency peak: In children and adolescents, blunt abdominal trauma has an age peak in the 6- to 8-year-old group and another in 14- to 16-year-olds. Course and prognosis: The course and prognosis depend on the extent of organ injury as well as the patient’s state of shock. To rule out a dangerous injury to the abdominal organs, the affected person should seek medical attention even if the symptoms are minor. Minor injuries usually heal spontaneously and without consequences. In case of signs of shock such as hypotension (low blood pressure), tachycardia (heartbeat too fast: > 100 beats per minute), dizziness, pallor, cold sweat, the affected person should be taken to a hospital immediately. In the context of more severe injuries, internal bleeding may occur due to, for example, ruptures (tears) of one or more organs located in the abdominal cavity. If surgery is not performed quickly, a life-threatening condition develops.Children are more affected than adults by the effects of external force on the abdominal cavity. Their fat pad and musculature are not yet very developed, so the impact of force hits them more unchecked. In addition, a child’s organs have a higher fluid content. As a result, they rupture more quickly in the event of an impact, for example. Internal bleeding can quickly become dramatic in children, since children have less blood volume than adults.
