EARTHQUAKE KNOWLEDGE UPDATE

EARTHQUAKE KNOWLEDGE UPDATEkapak

ABDOMINAL INJURIES

Latif Yılmaz1 Ersin Borazan2

1Gaziantep University, Faculty of Medicine, Department of General Surgery, Gaziantep, Türkiye
2SANKO University, Faculty of Medicine, Department of General Surgery, Gaziantep, Türkiye

Yılmaz L, Borazan E. Abdominal Injuries. In: Kalenderer Ö, Servet E, editors. Earthquake Knowledge Update. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.99-113.

ABSTRACT

Earthquakes rank among the most devastating natural disasters, resulting in significant morbidity and mortality due to mass injuries. Abdominal injuries, although uncommon, pose a high risk of mortality due to their complexity and potential for complications. Abdominal trauma in earthquakes typically manifests as blunt trauma and crush injuries, with penetrating trauma being less prevalent. The most prevalent abdominal injuries during earthquakes involve the abdominal wall, spleen, and liver, while injuries to the gastrointestinal tract are less common. Furthermore, earthquake-induced abdominal injuries are more frequently accompanied by lumbar vertebrae and retroperitoneal injuries than non-earthquake trauma. The frequency of injuries may vary according to the severity of the earthquake, the durability of the structures, and the effectiveness of rescue efforts.

A rapid and accurate clinical evaluation of post-earthquake abdominal trauma is of vital importance. In hemodynamically unstable patients, the initial evaluation should be performed with FAST (Focused Assessment with Sonography for Trauma). In the presence of free fluid, the patient should undergo emergency surgery. When the FAST result is uncertain, or FAST is not available, diagnostic peritoneal lavage (DPL) can be used. In hemodynamically stable patients, the gold standard is computed tomography (CT) imaging; however, this is not feasible due to the risk of acute renal failure from exposure to debris and crush injuries. Therefore, CT imaging without intravenous contrast material is recommended. In patients who are initially stable but develop hypotension, peritoneal irritation, intraperitoneal free air, diaphragmatic rupture, or uncontrolled bleeding on follow-up, surgical exploration should be considered.

Abdominal trauma frequently necessitates surgical intervention, particularly in cases of splenic and hepatic injuries, severe intra-abdominal bleeding, intestinal perforations, and abdominal compartment syndrome, which can lead to significant morbidity and mortality. Crush syndrome, a condition resulting from crush injuries, can lead to critical complications such as acute renal failure, hyperkalemia, and metabolic acidosis due to rhabdomyolysis in patients who remain under debris for an extended period. This highlights the complexity of earthquake trauma and emphasizes the necessity for multidisciplinary management. Early diagnosis and prompt treatment of crush syndrome can significantly reduce mortality. Early diagnosis, rapid intervention protocols, and multidisciplinary collaboration are crucial for the effective management of abdominal trauma in earthquake conditions.

Keywords: Earthquakes; Abdominal injuries; Crush injuries; General surgery; Acute abdomen; Laparotomy

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