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Am Fam Physician. 2023;108(2):206-207

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Key Points for Practice

• Perform physical and ultrasound examinations in patients with abdominal trauma to identify patients who need immediate surgical exploration.

• Perform serial abdominal examinations in patients who have experienced abdominal trauma because missed bowel injuries are common.

• Do not rely on CT to exclude bowel injury in abdominal trauma because CT misses up to 28% of bowel injuries. 

From the AFP Editors

Traumatic bowel injury, including mesenteric injury, affects 1 in 5 cases of penetrating abdominal trauma and 1 in 100 cases of blunt abdominal trauma. Bowel and mesenteric injuries are challenging to identify in the context of multiple injuries; however, they need to be treated promptly to prevent significant consequences. The World Society of Emergency Surgery published guidelines for identifying and treating bowel injuries.

Assessment After Abdominal Trauma

Rapid assessment is essential in abdominal trauma because mortality increases by 1% for every three minutes in the emergency department. Initial assessment after trauma involves a primary survey for life-threatening injuries and a focused assessment with sonography for trauma (FAST) evaluation. Immediate surgical consultation is recommended if the FAST evaluation finds intra-abdominal fluid, especially in hemodynamically unstable patients. Peritoneal lavage, the withdrawal of abdominal fluid to assess for blood, has a lower positive predictive value than the FAST evaluation and results in unnecessary laparotomies.

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Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Michael J. Arnold, MD, Assistant Medical Editor.

A collection of Practice Guidelines published in AFP is available at

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