Abdominal trauma: pre-operative assessment and postoperative problems in intensive care

Although penetrating abdominal trauma is on the increase in Australia, blunt trauma continues to account for the majority of cases and usually presents a more challenging problem than the former. Diagnosis has been greatly facilitated by the widespread use of peritoneal lavage and computerised tomography. Conservative management of solid organ ruptures, especially of the spleen, is being increasingly utilised in selected cases. If haemorrhage continues following initial resuscitation, urgent laparotomy is required. Heroic attempts at achieving normo-volaemia in the presence of major haemorrhage must not be allowed to delay laparotomy. Postoperative problems such as intra-abdominal sepsis or visceral infarction usually have few if any localising features; more typically multiple organ failure insidiously develops. When no clear extra-abdominal cause exists, laparotomy must not be delayed.