Clinical examination

Clinical examination of the abdomen should always be undertaken as part of the primary survey. A conscious patient may complain of abdominal pain but in other cases, a patient with a distracting injury may less aware of their abdominal injury. Examination findings may be minimal even in significant injury and an index of suspicion must be maintained.

Inspection – of the injured abdomen may show evidence of bruising, abrasions or penetrating trauma. Abdominal distension is suggestive of intra-abdominal haemorrhage and in association with signs of hypovolaemia must be dealt with promptly. 

Palpation – of the abdomen should be carried out and patient response documented. It is of particular importance to palpate the renal angles and examine the external genitalia. Tenderness or guarding in any region must be noted and further investigated, but a multiply injured patient may not report much tenderness to palpation even with underlying injury. A rigid abdomen is due to leak of bowel contents into the peritoneum from a hollow viscus injury. Blood is by itself not a peritoneal irritant and, in a patient who has undergone a significant injury, serial examinations may demonstrate a gradually distending abdomen with little initial discomfort.

Rectal examination – is useful if it demonstrates bleeding or a high-riding prostate suggestive of a pelvic injury and involvement of the genitourinary tract. Anal tone and sensation should be tested however, you should be aware though that in a head or spinally injured patient these will not be appreciated and cannot be used to exclude a pelvic or neurological injury. 

Top-to-toe examination – including a log-roll is imperative to ensure there are no other injuries. Whilst it is vital to fully expose the patient to adequately visualise all areas, attention should be paid to temperature control. Hypothermia in trauma patients is associated with significant mortality. 

Learning Bite 

Remember that an unconscious or spinal-injured patient will not be able to feel or localise abdominal tenderness.