Abdominal Trauma - life or death for your characters

Diagnosing an injury within the abdominal cavity can sometimes be very difficult.  Fat and muscle can mask injuries and conceal bleeding.  The task may be made more complicated if the patient is in a coma or has other injuries.

 

If you are looking to create a life or death situation for one or more of your characters, injuries within the abdominal cavity - known as 'intra-abdominal injuries' -  are a good place to start.

I've compiled the following brief guide to help you.

 

Inside the Abdominal Cavity

 

The organs of the abdominal cavity are the stomach, liver, gall bladder, spleen, pancreas, small intestine, large intestine and the kidneys. 

 

These organs are either 'hollow' or 'solid', apart from the kidneys, which are both - the bean-shaped portion of the kidney is 'solid'; the blood vessels and the ureter (which carries the urine away from the kidney) are 'hollow'.

 

Blood vessels associated with these organs are, of course, also 'hollow'.
 

Damage to the Hollow Organs

 

The basic patterns of injury to the hollow organs are:

• Cutting or tearing of the  blood vessels, which then haemorrhage.

• Cutting or tearing of the blood vessels that leaves the associated organ without a blood supply.  This causes gangrene, where tissues die that are closest to the injury.

• Leakage of body fluids from a perforated hollow organ..

 

Damage to the Solid Organs

 

The basic patterns of injury to the solid organs are:

• Cutting or tearing of the blood vessels, which then haemorrhage.

• Cutting or tearing of the blood vessels that leaves the associated organ without a blood supply.  This causes necrosis or 'death' of the organ in extreme cases. 

• The tissues of the organ shatter, resulting in haemorrhage.

• Leakage of body fluids from a damaged organ.

 

Types of Injuries to the Abdominal Cavity

There are two types of injury - Blunt Abdominal Trauma and Penetrating Abdominal Trauma.

Blunt trauma will be something like a kick or an impact during a car accident, for example. 

Penetrating trauma can be a stab wound, a gunshot wound or being impaled on railings, for example.

Examples of Injuries caused by Blunt Trauma

i) Hollow Organs

For a crime writer, blunt trauma to the hollow organs of one of your characters can have a dramatic impact, because the symptoms may not appear immediately.  Your character can be walking and talking and then suddenly collapse  - and maybe die - without warning.

A blow to the abdomen may appear trivial initially, but inside the cavity, major damage may have occurred to the hollow organs and associated blood vessels.

Symptoms such as pain or bloating may not appear immediately after the blow, but by the time they do appear it may be too late.

Damage to the colon, which is the main part of the large intestine, will cause faeces to leak into the abdominal cavity.  This results in peritonitis if left untreated, which can be fatal.

Here is a video showing a doctor talking about the symptoms and causes of peritonitis.

If associated blood vessels are damaged, then they will haemorrhage, resulting in the collapse and possibly death of the victim.

Damage to the small intestine  and its associated blood vessels may also cause peritonitis and haemorrhage.

ii)Solid Organs

If the blunt trauma is inflicted to the right side of the lower ribs or abdomen, then damage to the liver is likely to occur. 

For mild to moderate trauma, the damaged parts of the liver will be cut away and the blood vessels will be sutured to stem the blood flow.  However, major trauma may cause the liver to 'explode' and the victim is unlikely to survive because of the intensity of the bleeding.

A ruptured spleen occurs with left-sided trauma.  The victim may not be aware of the damage that has been inflicted on their organ.  He or she will initially feel light-headed and their skin will become pale.  They may collapse because of blood loss.

Bleeding may stop spontaneously or the victim may lose so much blood that one or more transfusions are necessary to ensure his or her survival.

Here is a video showing an operation to repair a ruptured spleen after a car accident.  WARNING: Some people may find this video rather gory.

Examples of Injuries caused by Penetrating Trauma

The results of injuries caused by penetrating trauma are similar to those produced by blunt trauma.  A knife can slice through an organ or blood vessel and cause a haemorrhage.

A bullet can rip through the stomach and liver and ricochet off a rib, which causes it to change direction and perhaps enter the spleen or pancreas.  Alternatively, your character may only suffer a relatively minor injury because the bullet missed all the major organs and blood vessels.

Here is a video of an operation to repair an intra-abdominal injury caused by a bullet.

WARNING: Some people may find this video rather gory.

Diagnosis of Intra-Abdominal Trauma

The problem for the medical team is that a high proportion of major abdominal injuries do not have significant symptoms or physical findings beyond a pain in the abdomen.

The patient, or somebody who was with the patient, needs to supply as much information as possible about the incident, as certain injuries will be more likely in certain situations.

If there are cuts and bruises in the abdominal area, they may indicate a deeper injury.

The doctor will press in on the abdominal wall and release it suddenly to see how much it hurts the patient.  If the patient has peritonitis, the sudden release will cause severe pain.  The patient will require emergency surgery.

If the patient's abdomen is visibly swelling, it means that they are haemorrhaging and will require emergency surgery.

Here is a video showing emergency surgery being carried out on the mesocolon (the tissue that attaches the colon to the dorsal abdominal wall) after a car accident. 

WARNING:  Some people may find this video rather gory.

Other investigations include washing out the abdominal cavity with saline fluid to see whether there is any blood, urine, bile or faeces there, which indicates a lacerated organ. 

Alternatively, the patient may have a CT scan to see whether any of the organs are lacerated.

With blunt force trauma, in particular, the patient will be closely observed for the appearance of symptoms requiring treatment or changes in their symptoms, until the medical team are sure the patient is not severely injured.

I hope I have given you some ideas for either killing off your characters or bringing them back from the point of death - or maybe even allowing them to be completely unscathed by their experience. 

Don't forget to share a link to your book in the Comments section below.






 

 

Fingerprints v DNA



The ability to identify a suspect  from fingerprints left at a crime scene has been possible for more than a century.  Fingerprint evidence has one big advantage over DNA profiling - it can identify an individual.

 

Here is the reason why a DNA profile cannot categorically identify an individual.

 

A set of components or 'loci' on the DNA molecule is used to generate a profile.  These particular loci have been chosen for forensic purposes because they are known to show considerable variation between individuals.

The loci essentially represent a sample of a person's complete DNA profile. 

Relatives will share some DNA, of course.   However, there is a theoretical possibility that unrelated people will share the same DNA because the profile is, technically, a sample and not the complete profile.

 

Therefore, a DNA profile generated for forensic purposes will not be unique to an individual.

 

 

Photo courtesy of www.all-about-forensic-science.com

 

If the DNA profile of a suspect matches the profile generated from a crime scene stain, the scientist will express their opinion as to how likely it is that somebody else's DNA would match the crime scene stain.

 

If there is no reason to think that any of the suspect's relatives could have left the crime scene stain, then the scientist will say (in the UK) that if the DNA match between the suspect and the crime scene stain came from some unknown person unrelated to the suspect, the probability of a match would be one in a billion.

 

In other words, it is highly unlikely to be anybody other than the suspect's DNA at the crime scene - but the scientist does not state it actually is the suspect's DNA.

 

So, although DNA evidence remains a hot topic in forensics - and DNA profiling is highly discriminating - good old-fashioned fingerprint evidence is still able to attract research funding, particularly in relation to latent or 'hidden' prints.

 

Although there are a number of techniques to enhance latent fingerprints, only 10% of those left at a crime scene contain sufficient detail for identification.  Put another way, 90% of latent fingerprints found at a crime scene cannot be used as evidence in court.

Is anybody addressing this problem?  Well, yes they are.

 

I want to share an article with you about a new way of visualizing latent fingerprints on metal.

 

Gun and knife crimes are the scourge of the 21st century.  This new technique is particularly applicable to these offences, as knives, guns and bullet casings all have metal surfaces.

 

Here is the link:

 

http://www.sciencedaily.com/releases/2013/07/130702202907.htm

 

The researchers used colour-changing fluorescent films to enhance latent prints on metal surfaces.

 

Although the technique is still at the experimental stage, it looks very promising for the future.

Advances in DNA may have revolutionised forensic science and crime scene investigation, but there is always room for looking at old methods with new eyes.  Maximising fingerprint evidence will always be high on the list of research projects for the foreseeable future.
 

Which areas of forensic science would you like to see evolve in the future?  Do you think the advent of new techniques make creating crime fiction easier or more difficult?