The surgeon must be certain that he has the patient's attention and cooperation. Each abdominal quadrant should be examined separately. The presence of involuntary guarding confirms intra-abdominal injury, but this sign may be hard to define under these circumstances. Medial and lateral pressure on the iliac spine and pressure on the pubic symphysis are used to search for pelvic fractures. The presence or absence of femoral pulses should be noted.
Abdominal tenderness is more often due to intra-abdominal injury than to abdominal wall trauma.
If tenderness is present, the surgeon should reexamine the abdomen after a urinary catheter and a nasogastric tube are in place. Urinary retention and acute gastric dilation are not uncommon in these patients. Auscultation This is an essential part of the evaluation. Absent or significantly decreased bowel sounds are abnormal in a healthy young soldier and must be considered presumptive evidence of intra-abdominal injury. The University of Iowa.