Abdominal injury

Abdominal injury

Abdominal injuries can be open or closed. Open injuries are more often gunshot or stab, rarely cut. Closed injuries appear during transport accidents, falls from a height, strong blows to the abdominal wall.

Clinical picture

• • Open injuries: the presence of a wound opening, severe pain, tension in the muscles of the abdominal wall and positive symptoms of peritoneal irritation. With a wide wound channel, the omentum may fall out of the wound, intestinal contents and urine may enter. The clinical picture depends on the organ damaged by trauma – with damage to the liver and spleen, mesentery of the intestine, profuse bleeding occurs with signs of acute blood loss
  • With closed injuries, there is no defect in the skin of the abdominal wall. Often there are ruptures of the spleen with intra-abdominal bleeding (weakness, pallor of the skin, cold sweat, tachycardia, decreased blood pressure, tension in the muscles of the abdominal wall, dullness of percussion sound in sloping areas of the abdomen, a symptom of a roly-poly-stand – increased pain when the patient is in a horizontal position) – 35% , kidneys and urinary tract – 24%, liver – 18%, stomach – 10%, retroperitoneal organs – 10%, etc.

Diagnostics

• • Physical examination: the absence of hepatic dullness during percussion indicates a rupture of a hollow organ, dullness of percussion sound in sloping areas of the abdominal cavity indicates internal bleeding.
  • Plain radiography of the abdominal organs – a strip of gas under the diaphragm may indicate damage to a hollow organ.
  • Examination of the contents of the abdominal cavity using a rummaging catheter is indicated when the physical examination is not informative (for example, if the patient is unconscious)
  • Empty the bladder (catheter) and stomach (by inserting a nasogastric tube) beforehand
  • The catheter is inserted through an incision made in the midline of the abdomen below the navel. By injecting it into various parts of the abdominal cavity, it is possible, with the help of suction, to reveal the presence of blood, intestinal contents, and feces in it.
  • Very informative emergency laparoscopy, specifying the localization and nature of the damage.
  • In the absence of conclusive data and the persistence of doubts about damage to the abdominal organs, exploratory laparotomy is justified.
  • Some additional and special diagnostic methods
  • Intravenous pyelography helps to detect unilateral retention or absence of urine output. In addition, the surgeon needs information about the work of the kidneys in patients with multiple massive injuries of the abdominal organs.
  • Retrograde pyelography can detect ureteral rupture
  • Cystoureterography is a valuable diagnostic method for fractures of the pelvic bones and the presence of bleeding from the urethra
  • Ultrasound helps to identify damage to parenchymal organs, the presence of fluid in the abdominal cavity and retroperitoneal space.

Surgery

• • The most convenient access is median laparotomy.
  • The most important points in abdominal trauma surgery are timely diagnosis and emergency stop of intra-abdominal bleeding.
  • In emergency cases, it is likely that the abdominal aorta is crushed with a fist against the background of massive infusion therapy and immediate surgical intervention
  • Bleeding from the aorta and its main branches during the operation is temporarily stopped by applying a vascular clamp, while simultaneously performing resuscitation
  • In less severe cases, a thorough examination and treatment is performed after the recovery of the BCC and stabilization of the patient’s condition.
  • Retroperitoneal hematomas of the pelvis and lower abdomen
  • Surgical intervention is carried out after identifying the source of bleeding angiographically or with a progressive increase in retroperitoneal hematomas in volume, since in the majority of cases their occurrence is associated with fractures of the pelvic bones, and they, as a rule, cannot be revised.
  • Retroperitoneal hematomas of the upper abdomen (especially in the region of the duodenum, pancreas and renal pedicles) should be given special attention
  • Laparoscopic examination of hematomas helps to establish their nature, the presence of additional impurities (for example, bile, air)
  • With a retroperitoneal rupture of the duodenal wall, only its early detection and suturing contribute to the success of further treatment if the condition for additional surgical measures for decompression of the duodenum and high-quality drainage of the retroperitoneal tissue is observed
  • In case of transverse ruptures of the pancreas, the method of choice is its distal resection.
  • In case of liver damage, first of all, it will be necessary to perform careful hemostasis of wound surfaces.
  • Shallow but bleeding liver fissures are sutured with mattress or cruciform sutures.
  • In the presence of significant ruptures with an almost complete detachment of a part of the liver, this part is removed, if necessary, hepatomentopexy is performed.

See also: Spleen injury

ICD

• S30 Superficial injury of abdomen, lower back and pelvis
• S31 Open wound of abdomen, lower back and pelvis
• S35 Injury of blood vessels at the level of abdomen, lower back and pelvis
• S36 Injury of abdominal organs
• S37 Injury of pelvic organs
• S38 Crush and traumatic amputation of abdomen, lower back and pelvis
• S39 Other and unspecified injuries of abdomen, lower back and pelvis