Rom J Leg Med 15 (2) 141 – 148 (2007) © 2007 Romanian Society of Legal Medicine ________________________ *)Corresponding author, 1) Surgeon, MD, PhD, Spitalul Clinic de Urgenta Floreasca, Calea Floreasca no.8, Sector 1, Bucuresti, Romania, E-mail: claudiuturculet@yahoo.com 2) National Institute of Legal Medicine “Mina Minovici”, Sos. Vitan Birzesti 9, Sector 4 Bucharest 141 Criterii de evaluare clinica si medico-legala a gravitatii traumatismelor abdominale Claudiu Turculet 1* , Dan Dermengiu 2 , Mihai Marinescu 2 _____________________________________________________________________ Abstract:. Medical and forensic criteria for the assessment of abdominal trauma severity. The authors review the traumatic mechanisms involved in abdominal trauma and spectrum of possible internal organs injuries. A special attention was paid to the criteria that can differentiate between traumatic injuries and “iatrogenic” injuries determined by terminal CPR. Another delicate subject that is analysed is the forensic interpretation of delayed manifestation of abdominal trauma like duodenal or gastric contusions with delayed perforation and peritonitis, or sub capsular spleen haematoma with delayed rupture and hemoperitoneum. Key words: abdominal trauma, iatrogenic injuries egiunea abdominala este expusa agentilor traumatici care actioneaza in diferite circumstante: accidente rutiere, sportive, accidente casnice sau de munca, agresiuni. In marea majoritate a cazurilor, traumatismele abdominale sunt asociate cu traumatisme cranio-cerebrale, traumatisme toracice sau ale membrelor, traumatismele abdominale pure fiind intalnite in aproximativ 10% din cazuri. De aceea, evaluarea unui pacient cu traumatism abdominal trebuie facuta in contextul intregului tablou lezional, cu ierarhizarea concomitenta a gravitatii leziunilor. In cazul traumatismelor abdomino-pelvine grave, exista trei consecinte fiziopatologice majore care pot pune viata victimei in primejdie, si anume sindromul de hemoragie interna, sindromul peritoneal si socul traumatic. Sindromul de hemoragie interna apare in urma leziunilor in special de organe parenchimatoase, leziuni de pedicul vascular sau in urma leziunilor de vase mari abdominale. Semnele clinice in sindromul de hemoragie interna sunt cele ale socului hemoragic : scaderea tensiunii arteriale cu tendinta la colaps si cresterea alurii ventriculare, tegumente si mucoase palide, reci, oligo-anurie cu insuficienta renala acuta de cauza vasculara, Douglas sensibil sau dureros la palpare. Suspiciunea clinica de hemoragie interna cu hemoperitoneu se confirma prin examinarea imagistica a pacientului, care va decela prezenta hemoperitoneului si/sau leziunile de organe intraabdominale. R