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. 

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