Closed (blunt) trauma of the abdomen - an injury that is not accompanied by a violation of the integrity of the abdominal wall. These injuries are also called "non-penetrating". However, the absence of visual pathologies is not evidence of the preservation of internal organs. Closed abdominal injuries are accompanied by damage to the pancreas, spleen, liver, intestinal tract, bladder and kidneys, which affects the he alth of the patient and can lead to death.
Etiology
A blow to the stomach is considered the main cause of damage to internal organs. Most of the patients affected in this way were relaxed at the time of the injury. The muscles are at rest, which provokes the penetration of the impact force deep into the tissues. This damage mechanism is typical for the following cases:
- criminal incidents (punching or kicking in the stomach);
- falling from a height;
- car accidents;
- sports injury;
- indomitable cough reflex accompanied by a sharp contraction of the abdominal muscles;
- industrial disasters;
- natural or military disasters.
At the moment of exposure to a detrimental factor that causes bruising of the abdominal wall, the presence of obesity and, conversely, exhaustion or weakness of the muscular apparatus increase the risk of damage to internal organs.
Combined injuries are common clinical cases, connecting blunt injuries of the abdomen with fractures of the bones of the extremities, pelvis, ribs, spine, craniocerebral trauma. Such a mechanism causes the development of large blood loss, aggravates the patient's condition and accelerates the onset of traumatic shock.
For any minor injury, you should go to the nearest emergency room. Working around the clock, employees will provide first aid, deciding on further hospitalization and the presence of internal injuries. Note! In the case of a serious condition of the victim or with any suspicion of a rupture of the internal organ, independent movement of the patient is contraindicated. Be sure to call an ambulance.
Classification
Blunt abdominal injuries are divided according to the following principles:
- Without the presence of damage to the abdominal organs (bruises, ruptures of muscle groups and fascia).
- With the presence of damage to internal organs located in the peritoneal space (ruptures of the liver, spleen, sections of the intestinal tract, bladder).
- With damage to the retroperitoneal organs (rupture of the pancreas, kidney).
- Pathology with intra-abdominal bleeding.
- Injuries accompanied by the threat of peritonitis (traumatization of hollow organs).
- Combined damage to parenchymal and hollow organs.
Pain syndrome
Closed abdominal trauma is characterized by the first and main complaint from the victim - the appearance of pain in the abdomen. It is important to remember that the erectile phase of shock may be accompanied by suppression of the pain syndrome, which complicates the diagnosis of pathology. In the case of combined injuries, pain from a fracture of the ribs or bones of the limbs, the pelvis can push the symptoms caused by the blunt abdominal trauma to the background.
The torpid stage of the shock state depresses the brightness of disease states due to the fact that the patient is disoriented or unconscious.
The nature of the pain syndrome, its intensity and irradiation of sensations depend on the location of the damage and the organ involved in the process. For example, a liver injury is accompanied by a dull aching pain that radiates to the region of the right forearm. Rupture of the spleen is manifested by irradiation of pain in the left forearm. Damage to the pancreas is characterized by girdle pain, which responds in the region of both collarbones, lower back, and left shoulder.
Rupture of the spleen, the consequences of which are severe for the patient due to excessive blood loss, accompanies a third of all closed abdominal injuries. Frequent cases are damage to the spleen and left kidney. Often the doctor has to re-operate on the patient if he did not see the clinical picture.one of several injured organs.
Traumatization of the upper part of the intestinal tract, accompanied by rupture of the walls, is manifested by a sharp dagger pain that appears due to the penetration of intestinal contents into the abdominal cavity. From the brightness of the pain syndrome, patients may lose consciousness. Colon injuries are less aggressive in presentation because the contents are not highly acidic.
Other clinical signs
Blunt abdominal trauma is manifested by reflex vomiting. In cases of rupture of the walls of the small intestine or stomach, the vomit will contain blood clots or have the color of coffee grounds. Similar discharge with feces indicates trauma to the colon. Injuries to the rectum are accompanied by the appearance of red blood or its clots.
Intra-abdominal bleeding is accompanied by the following symptoms:
- weakness and drowsiness;
- dizziness;
- appearance of "flies" before the eyes;
- skin and mucous membranes become bluish;
- low blood pressure;
- weak and rapid pulse;
- rapid shallow breathing;
- appearance of cold sweat.
Injuries to hollow organs cause the development of peritonitis. The body of the victim responds to such a pathology with a rise in body temperature (with severe blood loss - hypothermia), indomitable vomiting, and stopping the peristalsis of the intestinal tract. The nature of pain sensations is constantly changing, severe pain alternates with itstemporary disappearance.
Traumatization of the urinary system is accompanied by the absence or violation of urine output, gross hematuria, pain in the lumbar region. Later, swelling develops in the perineum.
Injuries without trauma to internal organs
Contusion of the anterior abdominal wall is manifested by local visual changes:
- puffiness;
- hyperemia;
- soreness;
- presence of bruises and abrasions;
- hematomas.
Pain that accompanies a bruise increases with any change in body position, sneezing, coughing, defecation.
Blunt abdominal trauma may be accompanied by fascial ruptures. The patient complains of severe pain, a feeling of bloating. There is a dynamic paresis of the intestinal tract, and, accordingly, the dynamic nature of the obstruction. Rupture of muscle groups is accompanied by local manifestations in the form of punctate hemorrhages or large hematomas, which can be localized not only at the site of injury, but also far beyond it.
The final diagnosis of "damage to the anterior abdominal wall" is made in case of confirmation of the absence of internal pathologies.
Diagnostic measures
Differential diagnosis of the patient's condition begins with the collection of anamnesis and trauma. Further, the determination of the condition of the victim includes the following methods of examination:
- General analysis of peripheral blood shows all signs of acuteblood loss: decrease in erythrocytes and hemoglobin, hematocrit, leukocytosis in the presence of an inflammatory process.
- General urinalysis detects gross hematuria, and if the pancreas is damaged, the presence of amylase in the urine.
- From instrumental examination methods, bladder catheterization and the introduction of a probe into the stomach are used.
- Ultrasound examination.
- Computed tomography with intravenous contrast.
- X-ray.
- Other examinations as needed (cystography, rheovasography, ERCP).
Differentiation of pathology
The study of the abdominal cavity and the organs located there should be multilateral, since concomitant injuries can suppress the symptoms of one injury, bringing to the fore the clinic of another injury.
| Organ | Clinical signs | Differential tests |
| Anterior abdominal wall | Soreness and muscle tension on palpation, when determining a volumetric formation, check for the presence of a hematoma. | You can distinguish a hematoma from a neoplasm using a test: the patient lies on his back and strains his muscles. The hematoma will be felt both when tense and relaxed. |
| Liver | Pain in the projection of the organ, often simultaneously with fractures of the lower ribs on the same side. Increased abdominal volume, hypovolemia. |
CT: organ rupture with bleeding. OAC detects anemia, low hematocrit. Ultrasound - intra-abdominal hematoma. Retrograde cholangiography indicates damage to the biliary tract. DPL - blood available. |
| Spleen | Soreness in the projection, combined with fractures of the ribs. Pain radiates to left shoulder. |
CT: ruptured spleen, active bleeding. OAK - decrease in hematocrit and hemoglobin. DPL detects blood. Ultrasound shows an intra-abdominal or intracapsular hematoma. |
| Kidneys | Pain in the side and lower back, blood in the urine, fractures of the lower ribs. |
OAM - gross hematuria. CT of the pelvis: slow filling with a contrast agent, hematoma, possible hemorrhage of internal organs located near the site of injury. |
| Pancreas | Pain in the abdomen radiating to the back. Later, muscle tension and symptoms of peritonitis appear. |
CT: inflammatory changes around the gland. Increased serum amylase and lipase activity. |
| Stomach | Dagger pain in the abdomen due to the release of the acidic contents of the organ into the abdominal cavity |
X-ray: free gas below diaphragm. The insertion of a nasogastric tube detects the presence of blood. |
| Thin part of the intestinal tract | Plate belly,accompanied by a painful diffuse syndrome. |
X-ray: presence of free gas under diaphragm. DPL - positive tests for things like hemoperitoneum, bacteria, bile or food. CT: presence of free fluid. |
| Large intestine | Pain with tense abdomen, presence of blood on rectal examination. In the early period without a clinic of peritonitis, then a board-like abdomen with diffuse soreness. |
X-ray indicates free gas under diaphragm. CT: Free gas or mesenteric hematoma, leakage of contrast into the abdominal cavity. |
| Bladder | Impaired urination and blood in the urine, pain in the lower abdomen. |
CT detects free fluid. In KLA increased urea and creatinine levels. Cystography: release of contrast outside the organ. |
Trauma center, providing round-the-clock medical care, is not able to carry out all these diagnostic methods, therefore, after the initial examination, the victim is sent to the hospital of the surgical department.
First Aid for Abdominal Trauma
If internal organ damage is suspected, the following rules should be followed:
- The patient is laid on a hard surface, providing a state of rest.
- Apply ice to the injury site.
- Don't give water or food to the victim.
- Do not take medicine until the ambulance arrives,especially analgesics.
- Ensure transportation to a he alth facility if possible.
- In the presence of vomiting, turn the patient's head to the side so that aspiration of vomit does not occur.
Principles of care
Blunt abdominal trauma requires immediate intervention by specialists, since a favorable result is possible only with timely diagnosis and treatment. After stabilization of the victim's condition and anti-shock measures, surgical intervention is indicated for patients. Closed injuries require the following conditions during operations:
- general anesthesia with adequate muscle relaxation;
- mid-median laparotomy, allowing access to all areas of the abdominal cavity;
- simple in technique, but reliable in terms of the result of the event;
- intervention is short in time;
- use uninfected blood poured into the abdominal cavity for reinfusion.
If the liver is damaged, stop bleeding, excision of non-viable tissues, suturing are necessary. Rupture of the spleen, the consequences of which can lead to the removal of the organ, requires a thorough revision. In the case of a minor injury, bleeding stop with suturing is indicated. With severe damage to the organ, splenectomy is used.
Ruptures of the intestinal tract are accompanied by the removal of non-viable tissues, stopping bleeding, revision of all loops, if necessary, bowel resection is performed.
Injury to the kidneys requires organ-preserving interventions, but with severe crushing or separation of the organ from the supply vessels, nephrectomy is performed.
Conclusion
The prognosis of traumatization of the abdominal organs depends on the speed of seeking help, the mechanism of damage, the correct differential diagnosis, and the professionalism of the medical staff of the medical institution providing assistance to the victim.
