Fractures of the ribs commonly produce penetrating chest trauma when sharp bone ends pierce tissues. Abdomen
Penetrating abdominal trauma (PAT) typically arises from stabbings, ballistic injuries (shootings), or industrial accidents. PAT can be life-threatening because abdominal organs, especially those in the retroperitoneal space, can bleed profusely, and the space can hold a large volume of blood. If the pancreas is injured, it may be further injured by its own secretions, in a process called autodigestion. Injuries of the liver, common because of the size and location of the organ, present a serious risk for shock because the liver tissue is delicate and has a large blood supply and capacity. The intestines, taking a large part of the lower abdomen, are also at risk of perforation. People with penetrating abdominal trauma may have signs of hypovolemic shock (insufficient blood in the circulatory system) and peritonitis (an inflammation of the peritoneum, the membrane that lines the abdominal cavity). Penetration may abolish or diminish bowel sounds due to bleeding, infection, and irritation, and injuries to arteries may cause bruits (a distinctive sound similar to heart murmurs) to be audible. Percussion of the abdomen may reveal hyperresonance (indicating air in the abdominal cavity) or dullness (indicating a buildup of blood). The abdomen may be distended or tender, signs which indicate an urgent need for surgery.The standard management of penetrating abdominal trauma was for many years mandatory laparotomy. A greater understanding of mechanisms of injury, outcomes from surgery, improved imaging and interventional radiology has led to more conservative operative strategies being adopted.
Assessment and treatment
Assessment can be difficult because much of the damage is often internal and not visible. The patient is thoroughly examined. X-ray and CT scanning may be used to identify the type and location of potentially lethal injuries. Sometimes before an X-ray is performed on a person with penetrating trauma from a projectile, a paper clip is taped over entry and exit wounds to show their location on the film. The patient is given intravenous fluids to replace lost blood. Surgery may be required; impaled objects are secured into place so that they do not move and cause further injury, and they are removed in an operating room. If the location of the injury is not obvious, a surgical operation called an exploratory laparotomy may be required to look for internal damage to the organs in the abdomen. Foreign bodies such as bullets may be removed, but they may also be left in place if the surgery necessary to get them out would cause more damage than would leaving them. Wounds are debrided to remove tissue that cannot survive and other material that presents risk for infection.Negative pressure wound therapy is no more effective in preventing wound infection than standard care when used on open traumatic wounds. History
Before the 17th century, medical practitioners poured hot oil into wounds in order to cauterize damaged blood vessels, but the French surgeon Ambroise Paré challenged the use of this method in 1545.