Abdominal trauma.

The proper management of abdominal injuries is essential to maximize the chances of survival of the multiply injured patient. Although the assessment of the abdomen must take place within the framework of the primary and secondary surveys of the patient, the critical management decision focuses on the need for exploratory laparotomy. The decision criteria for laparotomy can be grouped according to the bases of the decision. The more critical the patient, the more rapid the judgment for surgery must be. Thus, the patient with hypotension that is unresponsive to fluid resuscitation is the highest priority, followed by stable patients in whom the decision for laparotomy is made by physical examination, peritoneal lavage, and further studies. Diagnostic techniques, such as peritoneal lavage, and wound exploration must be used selectively. With the exceptions of abdominal films and frequently of an intravenous pyelogram, more sophisticated x-ray procedures usually are reserved for the most stable patients. Initial laboratory tests do not contribute significantly to the early management of the patient with abdominal injuries but are necessary to provide a baseline for further care. Early administration of antibiotics is important to minimize septic complications.