Evaluation and Management of Hemodynamically Stable Abdominal Penetrating/Blunt Trauma

External abdomen extends from the diaphragm to the infragluteal fold.

Divided into:

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  anterior abdomen

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  posterior abdomen

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  intrathoracic abdomen

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  flank.

Anterior abdomen

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  Extension

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    Superior: Transverse line through bilateral fourth intercoastal space (nipple level)

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    Inferior: Bilateral inguinal ligament

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    Lateral: Bilateral posterior axillary line

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  Divided into:

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    upper abdomen:

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      Extends between nipple line to transpyloric line (imaginary horizontal line between the suprasternal notch and the superior border of pubic symphysis)

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      Further divided into:

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        right hypochondrium

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        epigastrium

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        left hypochondrium.

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    Mid abdomen:

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      Extends between transpyloric line to intertubercular line (line between iliac tubercles)

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      Further divided into:

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        right flank

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        umbilical region

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        left flank.

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    Lower abdomen:

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      Extends between the intertubercular line and the inguinal ligaments

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      Further divided into:

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        right groin

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        hypogastric (suprapubic) region

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        left groin.

Posterior abdomen

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  Extension

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    Superior: Transverse line through the eighth intercostal space (angle of the scapula)

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    Inferior: Bilateral infragluteal fold

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    Lateral: Bilateral posterior axillary line

Intrathoracic abdomen

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  Extension

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    Superior: Transverse line through bilateral fourth intercoastal space (nipple level)

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    Inferior: Bilateral costal margins

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    Lateral: Area between the anterior and posterior axillary lines extending from the sixth intercostal space superiorly and costal margins inferiorly

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    Posterior: Area between eighth intercostal space (angle of the scapula superiorly to costal margins inferiorly)

Flank: Area between midclavicular line and posterior axillary line extending from the costal margin superiorly to the iliac crest inferiorly

Intraperitoneal

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  Supramesocolic (above the mesentery of the transverse colon) structures

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    Liver

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    Stomach

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    Spleen

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  Inframesocolic sutures

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    Small intestine and its mesentery

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    Transverse colon and mesocolon

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    Uterus

Retroperitoneal (see illustration)

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  Supramesocolic (above the mesentery of the transverse colon) structures

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    Duodenum

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    Pancreas

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    Suprarenal midline vessels

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  Inframesocolic structures

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    Infrarenal midline vessels

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    Bilateral kidneys

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    Bilateral ureters

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    Urinary bladder

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    Ascending colon

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    Descending colon

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    Upper 2/3 of the rectum

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    Cervix