Surgical Acute Abdomen Following Abdominal Trauma: Diagnostic Priorities, Damage-Control Surgery, And Clinical Outcomes

Abstract

Trauma-associated surgical acute abdomen is a time-sensitive emergency in which delayed recognition of intra-abdominal hemorrhage, hollow-viscus perforation, or mesenteric ischemia can lead to shock, peritonitis, organ failure, and death. Blunt and penetrating mechanisms produce different but overlapping patterns of solid-organ, intestinal, mesenteric, and abdominal wall injury. Initial management depends principally on hemodynamic status, resuscitation response, and signs of peritoneal irritation. Focused assessment with sonography for trauma and contrast-enhanced computed tomography support rapid evaluation, although subtle bowel and mesenteric injuries may remain occult. Patients with persistent instability or clear operative findings require prompt exploration, whereas selected stable patients can undergo targeted imaging, observation, or diagnostic laparoscopy. Damage-control surgery prioritizes immediate hemorrhage and contamination control, temporary closure when necessary, and physiologic recovery before definitive reconstruction. Solid-organ bleeding may require packing, resection, or endovascular embolization; intestinal disruption may require repair or resection; and mesenteric avulsion demands assessment of perfusion and bowel viability. Outcomes depend on injury burden, speed of intervention, physiologic derangement, associated trauma, and institutional resources. This narrative review summarizes injury patterns, diagnostic limitations, operative strategies, and reported outcomes in trauma-related surgical acute abdomen, emphasizing timely decision-making and individualized surgical escalation.