Abdominal trauma in primary blast injury

Abstract

Abdominal PBI is uncommon but has the potential for significant mortality and morbidity, which may present many days after blast exposure. It is commoner after blast in enclosed spaces and under water.

The Time Has Come to Rethink our Mass Casualty Preparedness Level in Response to Terrorist Attacks: Initial Contribution from the Department of War Surgery in Gülhane Military Medical Academy

“…A primary blast wave inflicts the gas-containing organs, such as ears, lungs, and intestinal organs, and may be overlooked by most clinicians if not military affiliated (11). Pulmonary primary blast injury may be evident upon presentation or may manifest as late as 48 hours from the time of the explosion (12).…”

Blast injury: A case study

“…When a high-explosive detonates (such as gelignite, trinitrotoluene, C4 or Semtex), an increase in air pressure is created, known as an overpressure or blast wave, which travels supersonically up to 8000 m/s (Cullis, 2001). This overpressure attains its peak pressure in the first few milliseconds following the blast (Owers et al, 2010), and can reach pressures of 20-30 kbar, where 1 kbar is 1000 times atmospheric pressure (Kocsis and Tessler, 2009). As the blast wave expands, the energy of the blast wave dissipates and the pressure decreases.…”

“…Cho et al (2010) conducted a study of 133 combat casualties with colonic injuries, and found 71% acquired injuries through the blast wave and fragmentation, reflecting the use of IEDs. However, abdominal injury is less common than lung injury (Owers et al, 2010), and not as common as extremity wounds (Barker, 2001).…”

“…Individuals close enough to the detonation to suffer PBI usually have overwhelming secondary blast injuries (Horrocks, 2001) including ocular and maxillofacial trauma (Bridges, 2006), but those wearing body armour can be protected by injury from fragmentation (Desmoulin and Dionne, 2009), and may survive to exhibit PBI (Owers et al, 2010) as body armour will not protect from the blast wave (Dougherty et al, 2011). The literature supports the theory that body armour has allowed for increased survival rates from decreased thoracic wounds (Rosenfeld and Ford, 2010;Dougherty et al, 2011), however, Propper et al (2010 states that insufficient evidence exists to support this theory.…”

“…In the abdomen, stress waves cause damage at the microscopic level, whereas the shear wave causes tearing of the tissues due to gross body wall and visceral motion. Laceration of solid abdominal viscera is related to very high blast loading (Owers et al, 2010).…”