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EVALUATION OF ABDOMINAL TRAUMA 2003 American College of Surgeons

David V. Feliciano, MD, FACS Committee on Trauma

Grace S. Rozycki, MD, FACS Subcommittee on Publicatons

Airway, Breathing, Circulation


Blunt Mechanism of Injury Penetrating

(Evaluation by Surgeon)

Observation 1 Further Diagnostic Tests Immediate Operation Anterior Stab Wound 4 Gunshot Wound Asymptomatic Flank/Posterior Stab
Normal exam High-risk mechanism Peritonitis on exam or Gunshot Wound 6
Altered mental status Hypotension with DPL
Equivocal abdominal exam or ultrasound
Ongoing blood loss Evisceration
Hematuria Open pelvic fracture Normal exam OR Observe Double or Laparoscopy
Prolonged operation for other injuries Triple
Contrast CT
Immediate Operation
Peritonitis on exam
VS Stable VS Unstable Hypotension OR if
Evisceration Peritonitis
Proctorrhagia Hypotension Positive Positive
Ultrasound or CT Ultrasound or DPL 2 Hematuria

OR Laparotomy
Observe Surgeon to
Normal Abnormal/Equivocal Positive Negative x 24 hours consider DPL or
laparoscopy 5

OR Reevaluate and OR if
Observe If vital signs stable and Vital signs consider other Hypotension
ultrasound or CT deteriorate sources of Peritonitis

If no active OR based on
bleeding, abnormal CT
nonoperative and clinical 1 No ingestion of alcohol or illicit drugs; no head injury with GCS #13; no spinal 4 From costal margins to inguinal ligaments between anterior axillary lines.
management condition 3 cord injury; no injury to lower ribs, thoracolumbar spine, or pelvis. 5 Laparoscopy recommended for suspected diaphragmatic injury.
of solid organ 2 If ultrasound used, rule out pericardial tamponade before evaluating abdomen. 6 Flank = From 6th intercostal space to iliac crest between anterior and/or
injury 3 Abnormal CTintraabdominal fluid (not blood density), blood without solid organ posterior axillary lines; Back = From 7th intercostal space to iliac crest
injury, bowel wall thickening, peripancreatic fluid, free air. posterior to posterior axillary line.