The trauma patient: critical decision making. When to explore the abdomen. A South African perspective

Abstract

Groote Schuur Hospital Trauma Unit (GSHTU) manages 110 gunshot wounds (GSW) and 400 stabbings per month. Eighty per cent of all laparotomies are for GSW. Knowledge of the various regions of the abdominal cavity is vital in penetrating injuries. Intraperitoneal injuries tend to manifest early, while retroperitoneal injuries are treacherous in that delayed presentations are the norm. The diaphragm position at the time of penetrating injuries determines whether thoraco-abdominal injuries are intrathoracic only, combined diaphragm and abdominal, or diaphragm and abdominal injuries only. Special investigations commonly miss hollow visceral injuries, so careful clinical examination is of greater importance than ultrasound or computerized tomography scanning. Initial conservative management is recommended for the stabbed abdomen, but laparotomy is generally indicated for all abdominal GSW. Polytrauma victims generally do not have significant intra-abdominal injuries unless there is unexplained hypotension, unexplained reduced haemoglobin levels, denervated abdomens and distended abdomens with shock.