Abdominal injuries constitute a major group of all types of massive trauma. Nonpenetrating wounds present problems because of difficulty in recognition, extent of involvement, and the multiplicity of injuries which may exist. Since many fail to exhibit immediate symptoms, they are easily overlooked and are not suspected until peritonitis occurs. The magnitude of the trauma may mask abdominal symptoms when other conditions are more evident. Unconsciousness increases the delay both in diagnosis and treatment. With all such patients one must be alert to unusual signs or evidence of abdominal injury.
Unexplained shock which fails to respond to routine measures, particularly after treatment of an obvious injury, should arouse suspicion. Persistence of abdominal pain, tenderness, or the development of signs of peritoneal irritation demands explanation. The findings are usually more obvious with associated blood loss and extensive visceral damage. Such patients, when recognized early, and when definitive therapy is instituted, offer