Injuries to the bowel and bladder.

The initial challenge facing the traumatologist in the management of bowel and bladder injuries is prompt diagnosis. Intestinal perforations following penetrating trauma are caused by direct penetration or by blast effect, and are most commonly diagnosed by physical examination (signs of peritoneal irritation) or peritoneal lavage. Bowel rupture from blunt trauma is more difficult to diagnose and results from different mechanisms of injury including crushing between the spinal column and the offending blunt object, shearing of the bowel and mesentery at fixed points from sudden deceleration, and rupture secondary to sudden increase in intra-abdominal pressure. Bladder rupture is most commonly seen in association with pelvic fractures, and the diagnosis is made by a well-performed cystogram. This article presents essentials for diagnosis and therapeutic strategies.