Abdominal trauma remains one of the most life-threatening conditions encountered in emergency medicine and trauma surgery. It demands prompt recognition, meticulous evaluation, and swift intervention.
This article focuses on understanding abdominal trauma through an easy-to-remember and high-yield mnemonic: “CHEST WALL TRAUMA.”
Understanding Abdominal Trauma
Abdominal trauma refers to injury to the abdominal cavity and its contents due to blunt or penetrating forces. These injuries can involve:
- Solid organs (liver, spleen, kidneys)
- Hollow organs (stomach, intestines, bladder)
- Vascular structures (aorta, IVC, mesenteric vessels)
- Retroperitoneal organs (pancreas, kidneys)
It may present overtly or subtly, and delays in diagnosis can lead to fatal outcomes due to hemorrhage, sepsis, or organ failure.
Classification of Abdominal Trauma
| Type | Description | Common Causes |
|---|---|---|
| Blunt trauma | No skin break; organs injured internally | MVCs, falls, sports injuries |
| Penetrating trauma | Object pierces skin, injures organs directly | Gunshots, stab wounds, impalement |
| Blast injury | High-pressure explosive trauma affecting abdomen | War injuries, industrial blasts |
The Mnemonic: CHEST WALL TRAUMA
This powerful mnemonic summarizes a comprehensive checklist of symptoms, history points, and signs that help in systematic evaluation of a trauma patient.
CHEST WALL TRAUMA
- C – Consciousness loss
- H – Head trauma / Headache
- E – Emesis
- S – Sputum / Hemoptysis
- T – Trauma / Other injuries
- W – Weakness / Numbness
- A – Abdominal pain
- L – Last meal / drink
- L – Liquor influence?
- T – Temperature
- R – Runny nose / liquids from mouth
- A – Alertness
- U – Urination pain
- M – Memory loss / Vision change
- A – Abnormal seizures
Let’s explore each component in depth.
C – Consciousness Loss
Loss of consciousness (LOC) in abdominal trauma patients can indicate:
- Severe hemorrhagic shock
- Head trauma
- Neurogenic shock
- Hypoxia
Always check Glasgow Coma Scale (GCS). A GCS < 8 requires airway protection and possibly neurosurgical consultation.
H – Head Trauma / Headache
A patient with combined head and abdominal trauma may present with:
- Confusion or amnesia
- Headache
- Scalp hematoma
- Rhinorrhea or otorrhea (suggesting basilar skull fracture)
Multisystem trauma is common in road accidents. Don’t ignore the head while focusing on the abdomen.
E – Emesis (Vomiting)
Vomiting post-trauma could point toward:
- Increased intracranial pressure (ICP)
- Intra-abdominal bleeding
- Bowel obstruction or perforation
- Stress response (catecholamine surge)
Note if vomitus is bloody or feculent, which may guide diagnosis toward gastric injury or distal obstruction.
S – Sputum / Hemoptysis
Although primarily respiratory, hemoptysis may occur due to:
- Diaphragmatic rupture
- Lower chest trauma
- Contused lung with concurrent abdominal impact
A chest X-ray or FAST (Focused Assessment with Sonography for Trauma) can identify thoracoabdominal injuries.
T – Trauma / Other Injuries
Don’t miss associated injuries:
- Pelvic fractures → retroperitoneal bleed
- Long bone fractures → fat embolism
- Spinal injuries → neurogenic shock
Complete a secondary survey post primary resuscitation as per ATLS guidelines.
W – Weakness / Numbness
These neurological symptoms may arise due to:
- Spinal cord injury (thoracolumbar)
- Compartment syndrome
- Peripheral nerve injury
- Hypoperfusion of CNS
Check for neurovascular compromise in limbs and spinal tenderness.
A – Abdominal Pain
The hallmark symptom. But beware:
- Early stages may have no pain in retroperitoneal or duodenal injuries.
- Referred pain (e.g., left shoulder pain in splenic rupture – Kehr's sign)
- Guarding, rigidity, or rebound tenderness suggests peritonitis
Imaging is essential if pain is disproportionate or localized.
L – Last Meal / Drink
Essential before anesthesia or surgery:
- Prevents aspiration pneumonitis
- Helps in assessing gastric emptying
- Important in evaluating possible alcohol intoxication
Record exact time and type of last intake.
L – Liquor Influence?
Alcohol intoxication masks serious signs like:
- Hypotension
- Abdominal pain
- Level of consciousness
It also increases risk of trauma due to impaired reflexes and disinhibition.
T – Temperature
- Fever may indicate delayed perforation or sepsis
- Hypothermia is common in trauma, worsens coagulopathy (part of lethal triad: acidosis, hypothermia, coagulopathy)
Keep trauma patients warm, monitor core temperature, and start broad-spectrum antibiotics when suspecting intra-abdominal infection.
R – Runny Nose / Mouth Liquids
Fluid leaking from nose or mouth may indicate:
- Basilar skull fracture (CSF rhinorrhea)
- Oropharyngeal trauma
- Aspiration
- Gastric contents regurgitation
Assess for airway protection and possible tracheal intubation.
A – Alertness
A sudden drop in mental status warrants evaluation for:
- Hypovolemic shock
- Hypoglycemia
- Intracranial injury
- Ongoing bleeding
Always check pupil size, reaction, and sensorium.
U – Urination Pain
Hematuria or pain while urinating suggests renal or bladder injury, especially in:
- Blunt trauma with pelvic fracture
- Deceleration injuries
- Flank bruising (Grey-Turner’s sign)
Insert Foley catheter cautiously and monitor urine output—a key indicator of perfusion.
M – Memory Loss / Vision Change
These symptoms imply concomitant head trauma:
- Concussion
- Temporal lobe hemorrhage
- Occipital lobe injury
- Diffuse axonal injury
Visual acuity should be documented, and CT brain ordered if GCS ≤ 13 or other red flags present.
A – Abnormal Seizures
New-onset seizures post trauma = NEUROLOGICAL EMERGENCY.
Common causes:
- Post-traumatic epilepsy
- Intracranial hemorrhage
- Alcohol withdrawal
- Electrolyte imbalance (e.g., hyponatremia)
Treat with anticonvulsants and manage underlying cause.
Structured Table: CHEST WALL TRAUMA Mnemonic for Abdominal Trauma Assessment
| Mnemonic | Assessment Point | Clinical Significance |
|---|---|---|
| C | Consciousness Loss | Hypoxia, shock, head injury |
| H | Head Trauma / Headache | Skull fracture, intracranial bleeding |
| E | Emesis | Raised ICP, GI injury |
| S | Sputum / Hemoptysis | Diaphragmatic or lung injury |
| T | Trauma / Other injuries | Multisystem evaluation is key |
| W | Weakness / Numbness | Neurologic deficit, spinal trauma |
| A | Abdominal Pain | Peritonitis, visceral damage |
| L | Last Meal / Drink | Aspiration risk before surgery |
| L | Liquor Influence | Intoxication masks symptoms |
| T | Temperature | Sepsis or hypothermia |
| R | Runny Nose / Liquids from Mouth | Basilar skull fracture or aspiration |
| A | Alertness | Monitoring for deterioration |
| U | Urination Pain | Bladder or urethral trauma |
| M | Memory Loss / Vision Change | Neurological damage |
| A | Abnormal Seizures | Intracranial pathology or electrolyte issues |
Investigations in Abdominal Trauma
| Investigation | Purpose |
|---|---|
| FAST (Ultrasound) | Rapid bedside screening for intraperitoneal fluid |
| CT Abdomen (CECT) | Gold standard for stable patients |
| X-ray Abdomen & Chest | Look for free air (perforation) or diaphragmatic injury |
| Diagnostic Peritoneal Lavage (DPL) | For unstable patients without imaging |
| Blood tests (CBC, LFT, KFT) | Baseline status, bleeding risk, end-organ damage |
| Serum amylase/lipase | Rule out pancreatic injury |
| Urinalysis | Evaluate for hematuria |
Management Approach (ABCDE + Definitive Care)
Primary Survey (ABCDE):
- Airway with C-spine protection
- Breathing and ventilation
- Circulation and hemorrhage control
- Disability (GCS)
- Exposure and environment control
Definitive Management Includes:
- IV fluids / blood transfusion
- Surgical intervention (e.g., laparotomy, splenectomy)
- Non-operative monitoring (in hemodynamically stable solid organ injuries)
- Antibiotics in perforation or open wounds
- Tetanus prophylaxis
Prognostic Factors
| Factor | Effect on Outcome |
|---|---|
| Time to hospital | Early intervention saves lives |
| Hemodynamic stability | Unstable patients need urgent surgery |
| Organ involved | Spleen and liver have high mortality |
| Patient comorbidities | Diabetes, coagulopathy worsen outcomes |
| Presence of shock | Strong predictor of mortality |
Frequently Asked Questions (FAQs)
Q1. What is the most commonly injured organ in blunt abdominal trauma?
A: The spleen is the most commonly injured solid organ in blunt trauma.
Q2. What is the role of FAST in abdominal trauma?
A: FAST (Focused Assessment with Sonography in Trauma) detects free intraperitoneal fluid and guides early management in unstable patients.
Q3. When is laparotomy indicated in abdominal trauma?
A: Indications include:
- Hemodynamic instability
- Evisceration
- Peritonitis
- Positive DPL
- Gunshot wounds
Q4. Can abdominal trauma present with no external signs?
A: Yes. Especially in seat belt injuries, retroperitoneal bleeds, or delayed perforation.
Q5. How do we manage pediatric abdominal trauma?
A: Non-operative management is preferred in stable cases, especially for splenic or liver injuries. Pediatric patients need careful fluid monitoring.
