Abdominal Trauma

Blast injury to the abdomen has a long history in US military combat trauma and until recently was universally fatal. Owing to advances in modern body armor, prehospital care, and surgical management, many of the previously nonsurvivable blast-injured casualties are being saved. The unique mechanism of blast injury can cause numerous and severe abdominal injuries through primary blast effect injuring hollow viscera and secondary blast effect causing blunt or penetrating injury. Consequently, while the overarching principles of trauma care remain the same as in civilian trauma, the severity of many abdominal blast injuries requires an increased focus on early damage control surgery for control of hemorrhage and gross contamination, an emphasis on second-look abdominal exploration to reduce missed injuries and lower threshold for fecal diversion via ostomy creation for management of injuries to the colon, rectum, or perineum. Long-term complications are often related to patients having an open abdomen and a stoma and include ventral hernias, entero-cutaneous fistulae, and complications with stoma reversal. Future research is focusing on hemorrhage control further downrange on the battlefield to increase the number of causalities who can survive to reach surgical care and refining the use of fecal diversion to determine who benefits the most from this technique.