Abdomional Trauma: Intra-Operative Decisions and Options for Reconstruction

Abdominal trauma in dogs and cats occurs from penetrating injuries, including bite wounds and projectiles, and blunt force injuries associated with motor vehicle accidents. Immediate life threatening problems include severe hemorrhage, hyperkalemia associated with uroperitoneum, and peritonitis. There may also be life-threatening injuries to the central nervous system and thorax, and open fractures or luxations. The initial management should focus on eliminating life-threatening injuries, a rapid assessment focusing on the central nervous, respiratory, and cardiovascular systems, and appropriate resuscitation. Once the animal has been stabilized, it is re-evaluated and appropriate diagnostic tests, including abdominal and thoracic radiography, abdominal ultrasonography or computed tomography, and abdominal paracentesis may be performed. The abdomen is carefully evaluated for distension and bruising, especially around the umbilicus as this can indicate a marked hemoperitoneum. The presence or absence of a palpable bladder is also noted. A rapid ultrasound allows detection of any peritoneal fluid that may represent hemorrhage, urine or a developing peritonitis. Ultrasound guided abdominocentesis can provide useful information on the nature of peritoneal fluid. Samples obtained should be evaluated for PCV, creatinine, and lactate levels. In hemoperitoneum cases the peritoneal blood does not clot and has a PCV equal to or higher than that of the peripheral blood. Based on the results of these evaluations, the clinician can formulate an appropriate treatment plan and present rational options to owners.  [...]