Damage to internal organs symptoms. Blunt abdominal trauma in children: symptoms and treatment. Types of bruises and their symptoms

- an extensive group of severe injuries, in most cases posing a threat to the patient's life. They can be both closed and open. Open most often occur due to stab wounds, although other causes are possible (falling on a sharp object, gunshot wound). Closed injuries are usually caused by falls from a height, car accidents, industrial accidents, etc. The severity of injury in open and closed abdominal trauma can vary, but closed injuries are a particular problem. In this case, due to the absence of a wound and external bleeding, as well as due to the traumatic shock associated with such injuries or the patient’s serious condition, difficulties often arise at the stage of primary diagnosis. If an abdominal injury is suspected, urgent delivery of the patient to a specialized medical facility is necessary. Treatment is usually surgical.

ICD-10

S36 S30 S31 S37

General information

Abdominal injury is a closed or open injury to the abdominal area, both with and without violation of the integrity of the internal organs. Any injury to the abdomen should be considered as a serious injury requiring immediate examination and treatment in a hospital, since in such cases there is a high risk of bleeding and / or peritonitis, representing an immediate danger to the patient's life.

Classification of abdominal injuries

Colon rupture the symptomatology resembles ruptures of the small intestine, however, this often reveals tension in the abdominal wall and signs of intra-abdominal bleeding. Shock develops more often than with ruptures of the small intestine.

Liver damage occurs with abdominal trauma quite often. Both subcapsular cracks or ruptures, and complete detachment of individual parts of the liver are possible. Such liver injury in the vast majority of cases is accompanied by profuse internal bleeding. The patient's condition is severe, loss of consciousness is possible. With preserved consciousness, the patient complains of pain in the right hypochondrium, which can radiate to the right supraclavicular region. The skin is pale, the pulse and respiration is rapid, blood pressure is reduced. Signs of traumatic shock.

Spleen injury- the most common injury in blunt abdominal trauma, accounting for 30% of the total number of injuries with a violation of the integrity of the abdominal organs. It can be primary (symptoms appear immediately after the injury) or secondary (symptoms appear days or even weeks later). Secondary ruptures of the spleen are commonly seen in children.

With small tears, bleeding stops due to the formation of a blood clot. With major injuries, profuse internal bleeding occurs with accumulation of blood in the abdominal cavity (hemoperitoneum). Severe condition, shock, pressure drop, increased heart rate and respiration. The patient is concerned about pain in the left hypochondrium, irradiation to the left shoulder is possible. The pain decreases in the position on the left side with the legs bent and pulled up to the stomach.

Damage to the pancreas. Usually occur with severe abdominal injuries and are often combined with damage to other organs (intestines, liver, kidneys and spleen). Perhaps concussion of the pancreas, its injury or rupture. The patient complains of sharp pains in the epigastric region. The condition is severe, the abdomen is swollen, the muscles of the anterior abdominal wall are tense, the pulse is quickened, the blood pressure is reduced.

Kidney damage blunt abdominal trauma is rare. This is due to the location of the organ, which lies in the retroperitoneal space and is surrounded on all sides by other organs and tissues. With a bruise or concussion, there is pain in the lumbar region, gross hematuria (urine with blood) and fever. More severe kidney injuries (crushes or ruptures) usually occur with severe abdominal trauma and are combined with damage to other organs. Characterized by a state of shock, pain, muscle tension in the lumbar region and hypochondrium on the side of the damaged kidney, a drop in blood pressure, tachycardia.

Bladder rupture may be extraperitoneal or intraperitoneal. The cause is blunt trauma to the abdomen with a full bladder. Extraperitoneal rupture is characterized by false urge to urinate, pain and swelling of the perineum. It is possible to excrete a small amount of urine with blood.

Intraperitoneal rupture of the bladder is accompanied by pain in the lower abdomen and frequent false urge to urinate. Because of the urine poured into the abdominal cavity, peritonitis develops. The abdomen is soft, moderately painful on palpation, there is swelling and weakening of intestinal motility.

Diagnosis of abdominal trauma

Suspicion of an abdominal injury is an indication for the immediate delivery of the patient to the hospital for diagnosis and further treatment. In such a situation, it is extremely important to assess the nature of the damage as soon as possible and, first of all, to identify bleeding that may threaten the patient's life.

Upon admission, in all cases, blood and urine tests are mandatory, blood group and Rh factor are determined. Other research methods are selected individually, taking into account the clinical manifestations and severity of the patient's condition.

With the advent of modern, more accurate methods of examination, radiography of the abdominal cavity in case of abdominal trauma has partially lost its diagnostic value. However, it can be used to detect ruptures of hollow organs. An x-ray examination is also indicated for gunshot wounds (to determine the location of foreign bodies - bullets or shots) and if a concomitant fracture of the pelvis or damage to the chest is suspected.

An accessible and informative research method is ultrasound, which allows diagnosing intra-abdominal bleeding and detecting subcapsular damage to organs that can become a source of bleeding in the future.

If there is appropriate equipment for examining a patient with an abdominal injury, computed tomography is used, which allows you to study in detail the structure and condition of the internal organs, revealing even minor injuries and minor bleeding.

If a bladder rupture is suspected, catheterization is indicated - confirmation of the diagnosis is a small amount of bloody urine released through the catheter. In doubtful cases, an ascending cystography is necessary, in which the presence of a radiopaque solution in the paravesical tissue is detected.

One of the most effective diagnostic methods for abdominal trauma is laparoscopy. An endoscope is inserted into the abdominal cavity through a small incision, through which you can directly see the internal organs, assess the degree of their confirmation and clearly determine the indications for surgery. In some cases, laparoscopy is not only a diagnostic, but also a therapeutic technique, with which you can stop bleeding and remove blood from the abdominal cavity.

Treatment of abdominal injuries

Open wounds are an indication for emergency surgery. For superficial wounds that do not penetrate the abdominal cavity, the usual primary surgical treatment is performed with washing of the wound cavity, excision of non-viable and heavily contaminated tissues, and suturing. With penetrating wounds, the nature of the surgical intervention depends on the presence of damage to any organs.

Bruises of the abdominal wall, as well as ruptures of muscles and fascia, are treated conservatively. Bed rest, cold and physiotherapy are prescribed. Large hematomas may require puncture or opening and draining of the hematoma.

Ruptures of parenchymal and hollow organs, as well as intra-abdominal bleeding are indications for emergency surgery. Under general anesthesia, a median laparotomy is performed. Through a wide incision, the surgeon carefully examines the abdominal organs, identifies and eliminates damage. In the postoperative period, with an abdominal injury, analgesics are prescribed, antibiotic therapy is performed. If necessary, blood and blood substitutes are transfused during the operation and in the postoperative period.

A bruise is understood as traumatization of soft tissues without damage to the skin. The most common in medical practice are bruises of the extremities, and the most severe are bruises of internal organs that occur during a fall or direct blow.

How dangerous a bruise is depends on which part of the body is damaged. It is not always possible to detect a violation of the functionality of an organ immediately after an injury. Imaginary well-being with a bruise is not a reason to refuse a full medical examination.

The localization of the bruise largely determines the nature of the injury. The most dangerous are damage to the organs of the mediastinum. As a result, life-threatening conditions arise. There are pathologies of the lungs, heart, trachea, etc.

In medical practice, isolated and multiple bruises are distinguished. In the first case, one organ suffers, in the second - several. This condition is typical for road accidents and natural disasters.

Bruises are extremely dangerous, accompanied by a violation of the integrity of the organ and hemorrhages. In women, uterine contusion can lead to infertility, and if the pelvic organs are damaged, the kidneys and bladder suffer. With an unfavorable outcome, the victim may die.

In the case of ruptures of the internal organ, the prognosis is unfavorable, but much is determined by the intensity of exposure and associated complications. and internal organs is accompanied by fractures of bone tissue and their displacement. Fragments can damage the stomach, lungs, etc.

ICD 10 injury code

The International Classification of Diseases codes S39. Injuries of the genitourinary organs are assigned an ICD 10 code - S37.

The reasons

The vast majority of bruises of internal organs a person receives when falling. These are relatively minor injuries that do not require long-term treatment. Infants suffer more often than others - a child has serious bruises when falling from a changing table or from a stroller.

If the victim fell on his stomach, then there is a direct effect on the abdominal cavity. In the presence of strong abdominal muscles, the harm of injury is minimal. Much more dangerous bruising of internal organs in a car accident. The nature of the damage resulting from an accident is always individual. As a rule, these are multiple injuries of a complicated type.

Road traffic accidents lead to serious conditions, and it is not always possible to determine the nature of the damage. After the accident, the victim is not able to adequately assess his condition, and the consequences of bruises make themselves felt only after a lapse of time.

It is believed that a bruise is most dangerous when falling on the left side, which is associated with the location. On the right side is located, and she is the first to suffer in the event of a blow. The nature of the lesion upon impact is determined by the strength and area of ​​the traumatic element. If the mechanical load fell on the abdomen, then the presence of strong muscles and fat mass will protect against the severe consequences of a stomach bruise. When the blow was delivered with a blunt object with a small area, the appearance of wounds of an open nature is not excluded.

If the causes and consequences of injuries from falls and road accidents are understood, then household injuries are rarely dangerous. An exception is a bruise of the uterus, which affects the reproductive functions of a woman. Trauma can be caused by sex with a careless partner, as well as because of role-playing games.

As a result of hostilities and disasters, we are talking about contusions and bruises with a high risk of death. As with car accidents and natural disasters, it is not always possible to predict what the outcome of an injury will be.

Symptoms

When the limbs are damaged, there are no problems with the diagnosis. The occurrence of a crunch in the joint, stiffness and pain speak for themselves. When its back part turns blue, there are pains in lifting. Otherwise, injuries of the vital systems of the body manifest themselves. Symptoms of bruising of internal organs vary, depending on the strength of the blow and the location of the injury. The main features are:

• pain syndrome;
• an increase in the damaged organ in size;
• internal bleeding;
• violation of the functions of the bruised organ.

If the blow was delivered to the sternum, then cyanosis develops - a cyanotic coloration of the skin is observed when damaged. The main symptoms of liver injury are swelling and pain in the right side, while the liver is enlarged, which can be seen with the naked eye. In case of liver damage, it is also necessary to pay attention to neighboring organs and tissues - the spleen, kidneys, pancreas suffer no less when struck.

In children, the symptoms are blurred, but any injury is accompanied by severe pain. The kid declares the problem with hysterical crying, and if this is already an adult child, then he can show on himself which organ is bothering him.

In all cases, the main symptoms of a bruise include severe soreness. It is not possible to detect internal hematomas after a bruise without examination, but pay attention to other manifestations. Violation of consciousness, blanching of the skin and severe conditions are usually caused by internal hemorrhage. If not provided, then complications of injury, up to and including death, are possible.

When hit in the stomach, stomach cramps and soreness occur. In case of damage to the pelvic organs, uterine hematoma in women, the development of intestinal obstruction, and dysfunction of the most important organs of the digestive system are not excluded. The symptomatology of intestinal trauma is complemented by a feeling of fullness in the anus, which is associated with edema of the organ.

First aid

In case of internal bruising, cold should be applied to the affected area. Compress soft tissues and stop the hemorrhage. Cooling is also carried out to reduce pain and prevent inflammation. The victim must also be laid on a horizontal surface, which will reduce the load on the injured organs.

With severe pain, a non-narcotic analgesic should be taken. But he is banned in case of peritonitis. Any medical manipulations are carried out in consultation with the doctor, since pathological changes in the structure of internal organs are possible.

In case of damage to the vessels and the presence of bruising, it is necessary to apply a tight bandage. Without diagnostic studies, it is impossible to understand what to do and how not to harm the health of the victim.

Diagnostics

In the hospital, local diagnostics is prescribed by radiation methods. If radiography is suspected, ultrasound and MRI are performed to assess the condition of the soft tissues. If a bruise of the uterus and abdominal organs is expected, an abdominal ultrasound is prescribed.

How to recognize a rupture of the internal organs and distinguish it from other injuries? Such damage is accompanied by acute bleeding, which develops cardiovascular insufficiency. In this case, the doctor will prescribe an ECG.

Treatment

The main methods of providing medical care are determined by the location of the injury and the degree of mechanical impact on the organs. The symptoms and treatment of a pancreatic bruise will be different than for a cervical injury. After the diagnosis is made, the doctor prescribes painkillers and drugs to improve blood clotting. Treatment with physical factors allows you to get rid of hematomas and increases the ability to repair.

How to treat a bruised place in the absence of complications? In this case, the patient is sent home, offering bruising medicines and homeopathic remedies. You can rub the damaged area with ointments that have a resolving effect. Among the methods of treating bruises with folk remedies, they have proven themselves well. With the development of the inflammatory process, you will have to drink antibiotics, and it is necessary to treat the bruise in a hospital.

Treatment of bruising and rupture of internal organs involves surgical intervention. Injuries to the peritoneum, spleen and uterine wall require more serious therapy.

Surgical treatment

Severe bruises do not heal on their own. If intestinal rupture and gastric trauma are established, complications are suggested. With rapidly progressive diseases, treatment usually comes down to surgical intervention. The final method of treatment is determined by the symptoms of bruising of internal organs.

Indications for surgery are severe edema, signs of heart failure, peritonitis. With symptomatic manifestations of pancreatitis, surgery can be avoided, but the doctor must make sure that the injury is not life-threatening.

Rehabilitation

To improve local blood circulation, the damaged area is treated with therapeutic ointments. An interesting fact is that immediately after the injury, the patient needs cold, and after two or three days - heat. What rehabilitation period is required after surgery on the gastrointestinal tract depends on the severity of the damage. At the time of recovery, the patient is offered a sparing diet, peace, restorative physiotherapy.

Complications and consequences

Among the most severe consequences of bruising of vital organs is a fatal outcome. Complications resulting from bruises are associated with impaired function of the injured organ. If this is the digestive system, then there are problems with the stool, the production of gastric juice is disturbed, pancreatitis and intestinal obstruction develop. Insufficiency of damaged tissues is included in the list of complications and undesirable consequences of bruises of internal organs.

Dear readers of the 1MedHelp website, if you have any questions on this topic, we will be happy to answer them. Leave your feedback, comments, share stories of how you survived a similar trauma and successfully coped with the consequences! Your life experience may be useful to other readers.

4.3. Injuries of internal organs

Strong blows to the abdomen, chest, lumbar region, perineum, especially if they are accompanied by fractures of the ribs, sternum, pelvic bones, can damage the heart, lungs, liver, spleen, intestines, kidneys, bladder.

Heart damage. Several factors are involved in the mechanism of heart injury in blunt chest trauma:

1) direct physical impact on the organ with hemorrhage in its departments - myocardium, subendocardium or epicardium;

2) the influence of the central nervous system on the endocrine-vegetative regulation of the activity of the heart (stress);

3) various metabolic disorders in the myocardium (redistribution of the content of catecholamines, potassium, sodium, etc.), which lead to hypoxia and hypotension;,

4) hyperfunction of the sympathoadrenal system, as a result of which the cardiotoxic effect of catecholamines is enhanced.

There are four degrees (forms) of closed heart injury:

- shake;

Bruise (contusion);

Heartbreak;

Traumatic infarction.

Shake - the mildest form of closed heart injury. It is characterized by the rapid development of short and mild clinical and cardiographic changes. The victims complain of aching, quickly passing pains in the region of the heart.

The main symptom is arrhythmias (paroxysms of tachycardia, atrial tachycardia, atrial or ventricular extrasystoles), as well as conduction disturbances up to a complete, albeit transient, transverse blockade of the heart or one of the legs of the atrioventricular bundle (His bundle) Characteristic dizziness, fainting, short-term

hypotension.

At contusion of the heart subtle, non-penetrating myocardial ruptures are observed (the atria are affected more often than the ventricles), which may be accompanied by extensive hemorrhages that capture the subepicardial areas and the thickness of the myocardium. Sometimes they compress the small branches of the coronary arteries, which leads to the formation of subsequent

shchy cicatricial-changed areas. Often all the membranes of the heart are saturated with blood. At the same time, the myocardium becomes flabby, unevenly plethoric.

Characteristic persistent or paroxysmal pain in the region of the heart, arrhythmias, enlargement of the heart in diameter, shortness of breath, various changes on the ECG. In severe cases, heart failure develops.

Traumatic rupture of the heart - the most severe form of his closed injury. Traumatic myocardial ruptures are a common cause of death: they are observed in 10-15% of all deaths in car accidents.

Ruptures of the right ventricle of the heart occur less frequently than the left ventricle; in 30% of injuries, they are multi-chamber in nature; in Oz patients, pericardial ruptures simultaneously occur; in the rest, the pericardium remains unaffected, but there is a threat of cardiac tamponade with blood, and subsequently, with a favorable outcome, - development of pericarditis.

Cases of ruptured traumatic aortic aneurysms characterized by high mortality are described.

A closed heart injury may also result in pericarditis (inflammation of the pericardium) , coronary thrombosis and traumatic myocardial infarction, "dislocation of the heart" and its "pressure", traumatic heart mink, arrhythmias, myocardial dystrophy.

Pleura and lung injury occur with bruises of the chest, its compression, fractures of the ribs and sternum, wounds with fencing weapons and track and field spears. In closed pleural injuries (without skin damage), the main role usually belongs to the end of the broken rib.

Lung injury. In case of pulmonary contusion caused by a closed chest injury, characteristic the clinical picture of hemorrhage in the lung, which is usually asymptomatic: hemoptysis, especially in the first 3-5 days, chest pain, apparently associated with damage to the pleura, shortness of breath and weakened breathing in the corresponding area of ​​the lung, short-term fever, a moderate increase in the number of leukocytes in blood and a slight acceleration of sedimentation

erythrocytes.

Due to the short duration of the changes (5-7 days), the most informative x-ray examination performed on the first day after the injury.

When pneumonia is attached, there is an increase in symptoms, as well as a longer and higher temperature increase, a pronounced increase in the number of leukocytes in the blood and the appearance of young forms.

With a lung injury, hemothorax often develops - blood entering the pleural cavity, the clinical manifestations of which depend on the degree of blood loss, mediastinal displacement and compression of the lung by accumulated blood, the degree of destruction of lung tissue and a decrease in pulmonary ventilation. The development of hemothorax may be accompanied by acute pulmonary heart failure.

At severe trauma with multiple rib fractures there is a progressive development of respiratory failure caused by restriction of respiratory excursions and cough inefficiency.

One of the most severe and early complications of thoracic trauma is traumatic pleurisy. As a rule, it occurs already in the first three days after the injury. The effusion usually corresponds to the side of the injury, but may be bilateral or opposite. Characteristic complaints of chest pain and shortness of breath.

Pneumothorax - the presence of air or gas in the pleural cavity. The ingress of air into the pleural cavity inevitably leads to partial or complete collapse of the lung.

Depending on the cause of occurrence, traumatic, spontaneous (spontaneous) and artificial (therapeutic) pneumothorax are distinguished.

At open pneumothorax the pleural cavity communicates with the external environment through a gaping defect in the chest wall or bronchus.

At the same time, the pressure in the pleural cavity is equal to atmospheric pressure (for small defects, it decreases slightly when inhaling and increases when exhaling). The lung completely collapses and turns off from the act of breathing. The most severe phenomena occur due to the fact that the opposite lung, which in that case provides all gas exchange, begins to function under abnormal conditions. Negative pressure in a healthy pleural cavity cannot be balanced by a pliable and easily displaced mediastinum, which is under

the influence of atmospheric pressure shifts towards a healthy lung, as a result of which the functional ability of the latter is significantly reduced. Since the pressure in the intact pleural cavity fluctuates significantly during the respiratory phases, and remains approximately constant on the side where the open pneumothorax occurred, the mediastinal displacement increases with each breath, and decreases with exhalation. As a result, mediastinum

together with the vital organs contained in it, abundantly supplied with nerve receptors, it undergoes more or less sharp fluctuations, “ballots”. This leads to difficulty in blood flow through the vessels of the mediastinum and, above all, through the vena cava, disruption of the heart and the occurrence of severe shock reactions.

At closed pneumothorax there is no communication between the air in the pleural cavity and the external environment.

In the pleural cavity, this or that level of negative pressure is usually maintained, at least at the moment of inspiration. In this regard, the collapse of the lung on the damaged side is often incomplete. It partly takes part in gas exchange. The mediastinum is displaced slightly and its fluctuations are expressed to a small extent. Respiratory and circulatory disorders with closed pneumothorax are much less pronounced than with open pneumothorax, and are quickly compensated after a short period of disturbances that are largely reflex in nature (irritation of the pleura by infiltrated air)

Severe disorders occur with valvular pneumothorax, usually observed with small defects chest wall, lung tissue or bronchus. With this type of pneumothorax, atmospheric air is sucked into the pleural cavity at the moment of inspiration, and during exhalation, when the pressure in the pleural cavity rises, the defect is covered and does not allow air to pass in the opposite direction R In some cases, air enters the pleural cavity in the exhalation phase.

The amount of air in the pleural cavity gradually increases, the lung collapses and turns off from the act of breathing, and the mediastinum shifts to the healthy side, resulting in severe respiratory and circulatory disorders.

Urgent care. At open pneumothorax(chest injury) first aid is to apply an airtight bandage, at least temporarily transforming open pneumothorax into closed and reducing the fluctuations of the mediastinum. Deadly without such a bandage the outcome may occur even before the arrival of the ambulance. The simplest airtight bandage consists of several layers. gauze, richly soaked in Vaseline, over which compress paper or oilcloth is applied. After overlay tight bandage urgently needed delivery of the victim to a special medical institution.

closed pneumothorax, as a rule, does not require the use of urgent medical manipulations, if there is no significant displacement of the mediastinum. However, even with a closed pneumothorax, the patient must be taken to the hospital.

At valvular pneumothorax it is necessary to deliver the patient as quickly as possible to a medical institution, where he will be provided with emergency care (unloading the pleural cavity from excess air by puncture, i.e. inserting a special needle into the pleural cavity, in order to transfer valvular pneumothorax to open).

Abdominal injuries may occur at the moment of impact to the hypochondrium (with a football boot, projectile for throwing, when hitting surrounding objects, etc.), falling from a great height (during jumping into water) and through the mechanism of counter-strike against the spine and ribs (when skiing ). They are accompanied by phenomena of shock, expressed to one degree or another. Characteristically rapidly increasing internal bleeding (especially with ruptures of the parenchyma and capsule of the liver and spleen), pallor of the skin and mucous membranes, thready pulse, confusion or loss of consciousness, a sharp tension in the muscles of the abdominal wall. When the intestines are damaged, inflammation of the peritoneum develops - peritonitis.

Urgent care.

Traumatic injuries of the spleen account for 20 to 30% of all damage to parenchymal organs.

There are single-stage and two-stage ruptures of the spleen.

With simultaneous ruptures, simultaneous damage to the parenchyma and capsule occurs. In these cases, bleeding into the free abdominal cavity from a torn spleen occurs immediately after injury.

With a two-stage rupture, usually at the first moment only one parenchyma of the spleen is injured with the formation of a subcapsular hematoma. With a repeated moment, often under the influence of an insignificant visible cause, the capsule ruptures and the hematoma breaks into the free abdominal cavity. Between the moment of injury and the breakthrough of blood into the free abdominal cavity, a certain period of time passes, calculated from several hours to several weeks and even months.

The clinical picture in spleen injury varies depending on the severity of the injury, the time elapsed since the injury, and the presence of concomitant injuries to other organs. Leading are the symptoms of acute blood loss and shock, which are joined by signs of peritoneal irritation.

Usually, the victims complain of pain in the left hypochondrium, less often in the upper abdomen or throughout the abdominal cavity. The pain is often given to the left shoulder, left shoulder blade.

Irritation of the peritoneum with engorged blood leads to tension of the abdominal wall and severe pain on palpation.

Massive bleeding, in addition to local symptoms characteristic of intra-abdominal bleeding, leads to the development of common manifestations of acute blood loss: rapidly progressive weakness of the victim, the appearance of tinnitus, dizziness, nausea, vomiting, cold sweat, pale skin, visible mucous membranes, etc. In severe cases, the patient may develop agitation, impaired consciousness and a sharp drop in blood pressure.

With the formation of an extensive subcapsular hematoma, the stretching of the capsule with outflowing blood causes significant pain and a feeling of fullness in the left hypochondrium.

The prognosis depends on the severity of the injury to the spleen, the amount of blood loss and the nature of concomitant damage to other organs. Timeliness of surgical intervention is crucial for the outcome of the disease.

Urgent care. Cold on the affected areas, rest and urgent hospitalization (usually surgery is necessary).

Damage to the kidneys and bladder possible when struck in the lumbar region, abdomen (suprapubic region), falling from a height on the buttocks. In the latter case, the kidneys suffer as a result of a blow to the spine and lower ribs.

For direct damage to the kidneys, which is accompanied by their contusion, hemorrhages in the renal parenchyma, its edema and ischemia, vascular thrombosis and heart attacks, hematuria, acute renal failure are characteristic.

Damage to the kidneys is accompanied by a state of shock, the appearance of blood in the urine, or the formation of a perirenal hematoma. This can lead to acute renal failure.

The rupture of the bladder is accompanied by urinary retention, which quickly pours into the perivesical tissue. The state of shock is deepened by the phenomenon of intoxication.

Urgent care. Cold on the affected areas, rest and urgent hospitalization (usually surgery is necessary).

During accidents, not only external injuries are possible, which are diagnosed at the sight of a wound or an unnatural position of the limb, but also injuries to internal organs that pose a threat to the life of the victim due to the difficulty in diagnosing them. Sometimes they can be diagnosed only after a considerable time after the injury.

With injuries, ruptures of internal organs often occur, accompanied by severe internal bleeding. This happens if internal organs that contain large amounts of blood, such as the liver, kidneys, or spleen, are damaged. However, there are also injuries in which, as a result of a blow, severe tissue damage occurs, cells die, and the organ cannot function normally.

Symptoms

• Strong pain.
• Tense anterior abdominal wall.
• Feeling of fullness in the stomach.
• Hemoptysis.
• Shock symptoms.

The organs of the chest or abdomen can be injured by any sharp or blunt object during a traffic accident, for example, when the driver hits the steering wheel with his chest or stomach, or when a person falls on his chest or back. In addition, gunshot or stab wounds are possible.

Treatment

In case of injuries of internal organs, the patient needs urgent medical care. It is necessary to resort to intensive care measures as soon as possible. Usually such patients have to be urgently operated on to stop internal bleeding. In addition, only during the operation, the doctor can carefully examine and accurately determine the degree of damage to internal organs. Stopping bleeding depends on the degree of damage and its location; for example, damaged blood vessels can be cauterized with an electrocautery, pulled together, or stitched together with threads.

Stop bleeding

Bleeding (with a large area of ​​the wound) can be stopped with drugs, such as fibrin glue, or cauterization using electricity. If the tissues are so severely affected that they are not capable of regeneration, then the organ must be urgently removed without waiting for tissue death (necrosis) and poisoning of the whole organism with decay products. In case of damage to internal organs, the patient almost always has to inject preserved blood by drip and resort to measures to stabilize blood circulation. In addition, it is extremely important to ensure the vital functions of the body (respiration, heart function).

First aid for injuries of internal organs

The person providing first aid can give the body of the victim the position of a "folding knife" (put the victim on his back, slightly raising his legs). If the patient is excited and frightened, then it is necessary to try to calm him down. In case of damage to the lungs, the patient should be laid on his back so that the upper body is slightly elevated. All other therapeutic measures can only be applied by a doctor.

In case of pain in the abdomen or chest and the slightest suspicion of damage to the organs of the chest or abdominal cavity after an accident, you should immediately consult a doctor. With symptoms of shock, you should immediately call an ambulance. Symptoms of shock may include paleness, cold sweats, palpitations, and shallow, shallow breathing. Severe pain is also an important symptom of injuries of internal organs. The presence of damage to the abdominal organs can also be assumed from the tense anterior abdominal wall. If the lungs are damaged, the victim vomits or hemoptysis with light-colored foamy blood. With gastric bleeding, the patient feels fullness in the stomach and nausea.

After learning the circumstances of the incident and evaluating the symptoms of the injury, the doctor will establish a diagnosis and resort to appropriate therapeutic measures.

If an emergency operation is necessary, the doctor tries to take all necessary measures to save the damaged organ. However, during subsequent reoperation, the dead parts of the organ often have to be removed.

7014 0

In case of any injury to the anterior abdominal wall, the physician must anticipate possible damage to the organs of the abdominal cavity and retroperitoneal space. Isolated injury to the anterior abdominal wall is rare. So, according to B. S. Rozanov (1936), it is noted in 30%, and according to M. S. Arkhangelskaya-Levina (1941) in 39% of observations.

With damage to the anterior abdominal wall, characterized by a rupture of the muscles and aponeurosis of the anterior abdominal wall, it is difficult for a doctor who examines a patient for the first time to distinguish this suffering from a strangulated ventral, paraumbilical, inguinal hernia.

We are talking about such ruptures of the anterior abdominal wall, which in the first hours after the injury went unnoticed by both the patient and the parents. The first alarm signals appear when there is a sharp pain in the abdomen or a sudden protrusion of the anterior abdominal wall. The recognition of these sufferings is facilitated by studying the anamnesis (what was the child's behavior before the onset of pain or protrusion, under what circumstances was the appearance of complaints, what was the anterior abdominal wall before the patient's complaints).

When recognizing a traumatic hernia of the anterior abdominal wall, first of all, the time of its appearance, localization (white line of the abdomen, umbilical ring, inguinal regions), border, and condition of the skin are established.

With a hematoma of the anterior abdominal wall or a traumatic ventral hernia above the place of protrusion, a bluish coloration of the skin and a protective tension of the muscles of the anterior abdominal wall are determined. With percussion with a hernia over the protrusion, tympanitis is noted (when intestinal loops come out under the skin), and when the omentum prolapses - dullness. Traumatic hernias of the anterior abdominal wall without signs of intestinal obstruction do not require emergency surgical intervention. The operation is carried out as planned.

Treatment

Sometimes the doctor is faced with the acute question of the legitimacy and expediency of laparotomy in case of an extensive closed injury of the anterior abdominal wall, when there are symptoms that simulate damage to the abdominal organs. The clinical picture of abdominal trauma is caused by damage to the nerve plexuses innervating the anterior abdominal wall, muscle ruptures, hematomas and thicker anterior abdominal wall and preperitoneal hemorrhages. The leading symptoms with a significant injury to the anterior abdominal wall are often severe abdominal pain and poor participation in the act of breathing of the anterior abdominal wall. Here is a brief extract from the case history.

Patient V., aged 11, was admitted to the clinic on 10/XI 1967 with complaints of abdominal pain, nausea, and shortness of breath.

From the anamnesis, it was found out that the girl, Igran, fell on a bucket of water, hitting her stomach. She did not lose consciousness. After the fall, she felt a sharp pain in her stomach and shortness of breath.

Upon admission to the clinic, the general condition was disturbed. Lies on the right side with the hips brought to the stomach. No pathological changes were found in the lungs. Pulse 118 beats per minute, rhythmic, good filling and tension. BP 90/60 mmHg Art. On the skin of the abdomen on the right, an irregularly shaped abrasion measuring 4X3X1.5 cm with a bruise is determined. The abdomen does not participate in the act of breathing.

On palpation on the left it is soft, on the right it is tense. Sharp soreness is determined. The symptoms of Shchetkin and "Roly-Vstanka" are negative. There is no free fluid and gas in the abdominal cavity. Urination free, painless.

Diagnosis: bruised abdomen. Assigned rest, cold on the stomach. After 12 hours, the pain in the abdomen disappeared, breathing became even and deep.

In some cases, the picture of damage to the abdominal organs is so pronounced that the surgeon cannot refrain from diagnostic laparotomy.

Patient D., 7 years old, was admitted to the clinic on 14/IV 1969 with complaints of severe pain in the abdomen, headache.

Pain in the abdomen appeared after falling from the stairs to the ground. She didn't know how she fell. The parents took the girl to the hospital.

Objectively: general condition of moderate severity. The skin is pale, the tongue is wet. Pulse 138 beats per 1 minute, satisfactory filling and tension. BP 85/33 mm Hg. Art. On the part of the chest organs, no pathological changes were detected. The abdomen is sunken, does not participate in the act of breathing. On palpation, the entire length is tense and sharply painful. Positive symptom of Pasternatsky on the left. Free gas and fluid in the abdominal cavity are not determined. On rectal examination, there is an indistinct overhang of the anterior wall of the rectum. Urination free, painless.

Diagnosis: bruised abdomen, ruptured spleen?

70 ml of polyglucin was transfused intravenously, cold on the stomach. It was decided to conduct an observation. After 2 hours the patient's condition did not improve, there was pain in the abdomen and tension in the muscles of the anterior abdominal wall. 14/1V 1969 - laparotomy. During revision, a hematoma 6X5 cm in size was found in the root of the mesentery of the small intestine, no damage to other organs was detected. Recovery.

According to N. L. Kushch and G. A. Sonov (1972), if it is impossible to exclude damage to the organs of the abdominal cavity, diagnostic laparotomy should be preceded by laparoscopy.

With a minor injury to the anterior abdominal wall with the presence of abrasions on the skin, subcutaneous hematomas, local symptoms come to the fore: swelling, hemorrhage and soreness. The pain intensifies with a change in body position, tension in the anterior abdominal wall, coughing. In children, unlike adults, ruptures of the rectus abdominis muscles are rare. Hematomas of the anterior abdominal wall arising from trauma should not be opened. Only an extensive and festering hematoma is subject to autopsy.

Sometimes a bruise of the anterior abdominal wall can be fatal for the victim, due to pain shock. Children in such conditions lie calmly and indifferently. The limbs are cold to the touch, covered with drops of cold sweat. Pulse weak filling and barely perceptible. This shock must be differentiated from shock caused by damage to internal organs. A similar clinical picture can simulate profuse bleeding as a result of rupture of the liver or spleen. With blood flowing into the abdominal cavity, bloating and dullness during percussion in the flanks are determined. Both circumstances require immediate surgical treatment, while the latter is contraindicated in case of pain shock.

Patients with prolonged or recurrent shock require special attention (in case of damage to internal organs without clear local and general symptoms). These patients need hourly medical supervision in order not to miss damage to the parenchymal and hollow organs of the abdominal cavity. When it is impossible to exclude damage to the abdominal organs, laparoscopy is indicated, and if it is impossible to perform it, a diagnostic laparotomy is indicated.

G. A. Bairov, N. L. Kushch