Symposium on trauma. 3. Major problems in blunt and penetrating abdominal trauma

Many pitfalls exist in treating patients with blunt and penetrating wounds of the chest and abdomen. The thoracic and abdominal cavities should not be dissociated in the examiner's mind because apparently trivial lesions of one may be associated with serious lesions of the other. Constellations of injuries should be sought, especially in blunt and seat-belt injuries. Life-threatening damage may not be clinically obvious for days or even weeks. Peritoneal lavage, while valuable, should be carefully interpreted. Splenic injury is treated much more conservatively today than in the past with strenuous attempts made to preserve all or part of the organ. When splenectomy is unavoidable, decisions about the need for penicillin and pneumococcal vaccine are important and should include dose and frequency. Liver injuries are also treated more conservatively. Lobectomy is seldom necessary as assiduous local hemostasis and débridement (accompanied in about 3% of cases by ligation of the hepatic artery) are effective when good exposure and preliminary measures to achieve temporary hemostasis are obtained.