In case of suspected intra-
abdominal injury, fast transport of the patient to a suitable hospital is of high priority. The initial clinical examination aims at identifying patients with potentially life-threatening
bleeding that require emergency surgery. In patients with penetrating
trauma, laparoscopy is favoured to exclude suspected perforation of the peritoneum. If a peritoneal perforation is identified, exploratory
laparotomy is recommended to exclude or treat
lacerations of the hollow viscus. Although clinical examination should be performed its sensitivity and specificity of up to 82% and 45%, respectively, are not sufficient as the sole screening method. For the further diagnostic workup, diagnostic peritoneal lavage has been completely replaced by abdominal ultrasound examination in Germany and many other countries. Focussing not only on the detection of free abdominal fluid but also searching for parenchymal organ lesions and performing repeated examinations increases accuracy up to 96%, with specificity of 99.8% and sensitivity of 72.1%. Computed abdominal tomography with a helical scanner with and without intravenous
contrast media is currently the gold standard of imaging techniques to identify traumatic
abdominal injuries. A sensitivity of 97.2% and specificity of 94.7% can be achieved. False negative findings must be expected with hollow organ
injuries. Serial clinical and ultrasound examinations as well as lab testing in conjunction with repeated CT may help to identify such lesions. Increased intra-abdominal pressure (IAP) with consecutive
abdominal compartment syndrome and multiple organ dysfunction is a delayed complication from conditions such as severe intra-abdominal
bleeding, major
bleeding from pelvic ring fractures, and profuse fluid
resuscitation. The IAP should be measured routinely in patients at risk, and
decompression laparotomy may be indicated with pressures of higher than 20 mmHg.