Closed (blunt) trauma of the abdomen - damage 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 safety of internal organs. Closed abdominal injuries are accompanied by damage to the pancreas, spleen, liver, intestinal tract, bladder and kidneys, which affects the health 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 patients affected in this way were relaxed when injured. The muscles are at rest, which provokes the penetration of the force of impact deep into the tissues. This damage mechanism is characteristic of the following cases:
- criminal incidents (punched or kicked in the stomach);
- falling from height;
- car crashes;
- sports injuries;
- indomitable cough reflex, accompanied by a sharp contraction of the abdominal muscles;
- industrial disasters;
- natural or military disasters.
At the time 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 system increase the risk of damage to internal organs.
Common clinical cases are combined injuries that connect blunt abdominal injuries with fractures of the limbs, pelvis, ribs, spine, and head injury. Such a mechanism causes the development of large blood loss, aggravates the patient's condition and accelerates the appearance of traumatic shock.
For any minor injuries, contact your nearest emergency room. Working around the clock, employees will provide first aid, resolving the issue of 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 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 abdominal bleeding.
- Damage accompanied by the threat of peritonitis (trauma to the hollow organs).
- Combined damage to parenchymal and hollow organs.
Pain syndrome
Closed abdominal injuries are 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 can be accompanied by inhibition of pain, 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 that caused a blunt trauma to the abdomen into the background.
The torpid stage of a shock state depresses the brightness of painful conditions due to the fact that the patient is disoriented or is in an unconscious state.
The nature of the pain syndrome, its intensity and the 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 radiating to the region of the right forearm. Rupture of the spleen is manifested by the irradiation of pain in the left forearm. Pancreatic damage is characterized by girdle pain that responds in the area of both clavicles, lower back, and left shoulder.
Rupture of the spleen, the consequences of which are difficult 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 reoperate the patient if he does not see the clinical picture of one of several injured organs.
Injury to the upper part of the intestinal tract, accompanied by rupture of the walls, is manifested by sharp dagger pain, which appears as a result of penetration of intestinal contents into the abdominal cavity. From the brightness of the pain syndrome, patients can lose consciousness. Damage to the colon is less aggressive in manifestations, since the contents do not have a strong acidic environment.
Other clinical signs
Blunt trauma to the abdomen is manifested by reflex vomiting. In cases of rupture of the walls of the small intestine or stomach, vomit will contain blood clots or have the color of coffee grounds. Such excreta with feces indicate trauma to the colon. Rectal injuries are accompanied by the appearance of red blood or its clots.
Intraperitoneal bleeding is accompanied by the following symptoms:
- weakness and drowsiness;
- dizziness;
- the appearance of "flies" before the eyes;
- skin and mucous membranes acquire a bluish tint;
- low blood pressure;
- weak and frequent pulse;
- frequent shallow breathing;
- the appearance of cold sweat.
Damage to the hollow organs cause the development of peritonitis. The body of the victim responds to a similar pathology by a rise in body temperature (with severe blood loss - hypothermia), indomitable vomiting, and stopping of intestinal motility. The nature of pain is constantly changing, severe soreness alternating with its temporary disappearance.
Trauma to the urinary system is accompanied by the absence or violation of urine output, macrohematuria, pain in the lumbar region. Later, edema in the perineum develops.
Damage without trauma to internal organs
A contusion of the anterior abdominal wall is manifested by local visual changes:
- swelling;
- hyperemia;
- soreness;
- the presence of bruising and abrasions;
- hematomas.
The pain accompanying the bruise is aggravated by any change in body position, sneezing, coughing, or bowel movement.
A blunt abdominal injury may be accompanied by ruptured fascia. The patient complains of pronounced pain, a feeling of bloating. There is a dynamic paresis of the intestinal tract, and, accordingly, the dynamic nature of obstruction. The rupture of muscle groups is accompanied by local manifestations in the form of small-point hemorrhages or large hematomas, which can be localized not only at the site of trauma, but also far beyond it.
The final diagnosis of "damage to the anterior abdominal wall" is made in the case of confirmation of the absence of internal pathologies.
Diagnostic measures
Differential diagnosis of the patient's condition begins with a history and trauma. Further, the determination of the condition of the victim includes the following examination methods:
- A general analysis of peripheral blood shows all signs of acute blood loss: a decrease in red blood cells and hemoglobin, hematocrit, leukocytosis in the presence of an inflammatory process.
- A general urinalysis determines macrohematuria, and with damage to the pancreas, the presence of amylase in the urine.
- Of the instrumental methods of examination, catheterization of the bladder and the introduction of a probe into the stomach are used.
- Ultrasound examination.
- Computed tomography with intravenous administration of a contrast medium.
- Roentgenography.
- Other examinations if necessary (cystography, rheovasography, ERCP).
Pathology differentiation
The study of the abdominal cavity and organs located there should be multilateral, since combined injuries can inhibit the symptoms of one damage, highlighting the clinic of the injury of another.
Differential diagnosis of abdominal injury| Organ | Clinical signs | Differential tests |
| Anterior abdominal wall | Soreness and muscle tension during palpation, when determining the volumetric formation, the presence of a hematoma should be checked. | You can distinguish a hematoma from a neoplasm with the help of a test: the patient lies on his back and strains his muscles. The hematoma will be felt both in a tense and relaxed state. |
| Liver | Pain in the projection of the organ, often simultaneously with fractures of the lower ribs on the same side. An increase in the volume of the abdomen, hypovolemia. | CT: organ rupture with bleeding. KLA determines anemia, low hematocrit. Ultrasound - intra-abdominal hematoma. Retrograde cholangiography indicates damage to the biliary tract. DPL - blood available. |
| Spleen | Soreness in projection, combined with fractures of the ribs. The pain radiates to the left shoulder. | CT: rupture of the spleen, active bleeding. OAC - a decrease in hematocrit and hemoglobin. DPL detects blood. Ultrasound picture of intraperitoneal or intracapsular hematoma. |
| Kidney | Pain in the side and lower back, blood in the urine, fractures of the lower ribs. | OAM - macrohematuria. CT scan of the pelvis: slow filling with contrast medium, hematoma, possibly hemorrhage of internal organs located near the site of trauma. |
| Pancreas | Abdominal pain radiating to the back. Muscle tension and symptoms of peritonitis later appear. | CT: inflammatory changes around the gland. Increased serum amylase and lipase activity. |
| Stomach | Dagger abdominal pain due to the release of acidic organ contents into the abdominal cavity | X-ray: free gas located below the diaphragm. The introduction of a nasogastric tube determines the presence of blood. |
| The thin part of the intestinal tract | A plank-like stomach, accompanied by a painful diffuse syndrome. | X-ray: the presence of free gas under the diaphragm. DPL - positive tests for indicators such as hemoperitoneum, the presence of bacteria, bile or food. CT: presence of free fluid. |
| Colon | Pain with a tense stomach, the presence of blood during rectal examination. In the early period without a clinic of peritonitis, then a plank-like stomach with diffuse soreness. | An x-ray indicates free gas under the diaphragm. CT: free gas or mesenteric hematoma, contrast output to the abdominal cavity. |
| Bladder | Violation of urination and blood in the urine, pain in the lower abdomen. | CT determines free fluid. In the KLA, increased urea and creatinine levels. Cystography: contrast output beyond the organ. |
The emergency room, providing medical assistance around the clock, is not able to carry out all the indicated diagnostic methods, therefore, after the initial examination, the victim is sent to the hospital of the surgical department.
First aid for abdominal trauma
If you suspect damage to internal organs, the following rules should be followed:
- The patient is laid on a hard surface, provide a state of rest.
- Apply cold to the site of injury.
- Do not give the victim water and food.
- Do not take medicines until the ambulance arrives, especially analgesics.
- If possible, provide transportation to a medical institution.
- If there is vomiting, turn the patient’s head to the side so that vomiting does not aspirate.
Principles of Health Care
A blunt abdominal injury requires the immediate intervention of specialists, since a favorable result is possible only with timely diagnosis and the start of treatment. After stabilization of the victim’s condition and anti-shock measures, patients are shown surgical intervention. Closed injuries require the following conditions to be met during surgery:
- 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 results;
- the intervention is short in time;
- uninfected blood poured into the abdominal cavity for reinfusion.
If the liver is damaged, stopping bleeding, excision of non-viable tissues, and suturing are necessary. Rupture of the spleen, the consequences of which can lead to the removal of the organ, requires a thorough audit. In case of minor injury, bleeding is stopped with closure. With severe damage to the organ, splenectomy is used.
Gaps in the intestinal tract are accompanied by the removal of non-viable tissues, stopping bleeding, revision of all loops, if necessary, intestinal resection is performed.
Damage to the kidneys requires organ-preserving interventions, but with a strong crush or separation of the organ from the supply vessels, a nephrectomy is performed.
Conclusion
The prognosis of trauma to the abdominal organs depends on the speed of seeking help, the mechanism of damage, proper differential diagnosis, and the professionalism of the medical staff of the medical institution that provides assistance to the victim.