The pathophysiology of primary blast injury and its implications for treatment. Part II: The auditory structures and abdomen.

The authors have previously considered the mechanisms by which primary blast injury affects the respiratory and cardiovascular systems and what deductions may be made about management of the resulting injuries. This article considers the somatic effects of primary blast on abdominal and auditory structures. These injuries are usually of less immediate concern but require accurate management in order to avoid late mortality and morbidity and to return the casualty to full function. Recognition of likely injury patterns is vital to the instigation of correct management. The tympanic membrane, for instance, is easily damaged by blast and such an injury may be complicated by ossicular disruption, perilymph fistula or forceful distribution of squamous epithelium around air filled spaces with potential to form cholesteatoma. Abdominal organs can be severely disrupted by primary blast. The treatment of such injuries is not dissimilar to that of any other cause of abdominal trauma. The most challenging aspect is the identification of intestinal intramural haemorrhage and discrimination between those lesions destined for perforation or for spontaneous recovery. In this article the range and mechanism of injury are described for each system, drawing on experience from other modes of injury closely related to blast, followed by suggestions for their management established from literature reviews and experimental work undertaken by the authors during periods of full time research.