Signs of damage to internal organs in a child. Abdominal injury in a child: what to do

Injuries associated with mechanical impact on the human body are the most common in medical practice. The main reasons for their appearance:

Hit with a blunt object.
- Collision with an object with a high hardness (usually occurs in an accident).
- Falling from a great height.

Symptoms of bruises of internal organs

The main symptoms that allow us to draw conclusions about bruising of internal organs:

Severe pain in the affected area.
- The presence of a hematoma in this area.
- Swelling of soft tissues in the damaged area. This condition is usually caused by internal bleeding.
- Violation of the functionality of the organ that was affected.

Manifestations can be different, depending on which organ was affected. In general, external signs of bruising of internal organs can be described as follows:

Growing subcutaneous emphysema (excessive accumulation of air in the tissues, accompanied by severe pain).
- If the lungs are damaged, cyanosis (bluish discoloration of the skin), a disorder of respiratory function is observed.
- Decreased blood pressure, decreased heart rate.
- Injuries to the organs that are in the abdominal cavity are often manifested by a feeling of fullness in the stomach, nausea.
- Hemoptysis.

If the kidneys, liver, spleen are damaged, internal bleeding can be very severe. For any injury that provoked a bruise of internal organs, professional medical care is needed.

The main methods of treatment of bruises of internal organs

Ice or a cold compress should be applied to the bruised area.
- To avoid anaphylactic shock, the patient must take pain medication.
- In some cases, the imposition of a tight bandage is indicated (for example, with a closed chest injury).

Severe bruising of internal organs after the accident requires immediate hospitalization. In a hospital, a thorough diagnosis is carried out, which helps to identify the size and area of ​​\u200b\u200bspread of damage to internal organs. The main diagnostic methods are x-rays, and if the brain is bruised, computed tomography or magnetic resonance imaging (MRI) may be required. In case of a chest injury, the doctor will prescribe an ECG - an electrocardiogram, the decoding of which will help to get a more objective picture of the disease.

Treatment usually comes down to surgery, which is performed to stop internal bleeding and restore the integrity of the damaged organ. If the bruise was not strong, to eliminate the hematoma 3-4 days after the injury, you can rub the damaged area with ointments that have an anti-inflammatory effect (without a warming effect). A source -

According to medical statistics, trauma to various internal organs is almost the most common type of lesion, which also includes bruises. The number of blunt injuries of internal organs is also increasing significantly due to the fact that the number of road accidents has significantly increased in recent years.

Doctors distinguish these injuries into 2 types: with the development of internal hemorrhage into the organ and with damage to the integrity of the organ itself. Each of these pathologies is dangerous and requires immediate medical attention.

Causes

A bruise can be provoked by a variety of reasons, but most often the lesion occurs due to the following factors:

1. Striking the body with a blunt object;
2. Falling from height;
3. Falling on a hard object;
4. Collision with a hard object (while running or crashing).

Symptoms

Symptoms of the disease can vary significantly depending on which organ was affected. But the main signs of damage are:

• Severe pain in the area of ​​injury;
• The appearance of a hematoma (most often it has an impressive size);
• Edema. In most cases, it indicates the presence of internal hemorrhage;
• Deterioration of the functioning of the affected organ.

Very often, with such a lesion, patients also suffer from nausea and lowering blood pressure.

Consequences

Regardless of which internal organ was damaged, immediately after the injury, it is necessary to see a doctor who, after conducting a diagnosis, will identify what the patient has encountered.

Approximately 40% of these lesions require surgery. If the hemorrhage or tissue rupture is not eliminated in time, the consequences for the patient can be the most deplorable, up to death.

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.

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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 cyanotic color 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 pain in the abdomen 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

From childhood we are familiar with bruises. Bruises on the arms and legs are a common thing that you simply do not pay attention to. But damage to internal organs is an injury much more dangerous than bruising of soft tissues. At the slightest suspicion of hematoma of the liver, it is necessary to urgently consult a doctor.

Shulepin Ivan Vladimirovich, traumatologist-orthopedist, highest qualification category

The total work experience is more than 25 years. In 1994 he graduated from the Moscow Institute of Medical and Social Rehabilitology, in 1997 he completed residency in the specialty "Traumatology and Orthopedics" at the Central Research Institute of Traumatology and Orthopedics named after I.I. N.N. Prifova.

In most cases, bruising of the internal organ occurs when struck with a blunt object. But it can also be:

• sports injury(rugby, martial arts, football);
• consequence of an accident. Because the passenger is usually positioned sideways to the vehicle, it is the rib, liver, and thigh that are affected;
• the fall . As a rule, a fall from a great height (at least 2-3 meters) leads to a liver injury. But there are cases when the injury was even due to the fact that a person slipped on the ice;
• a sharp rise in weight;
• pinching between two objects. For example, it can be the doors of an elevator or a bus.

Depending on the nature of the damage, there are:

• liver hematoma. This is an accumulation of blood in the liver, which is limited to the muscle layers;
• ruptures - subcapsular (when the hemorrhage occurs under the capsule) and transcapsular (when the fibrous membrane of the liver is broken).

Symptoms of a liver injury. How to distinguish a bruise from a rupture

Since the nerve endings in the liver area are unevenly located, the pain syndrome can be both pronounced and practically absent. In most cases, there is local pain at the site of injury, including from damage to deep muscles. It is possible to spread discomfort in the lumbar and inguinal region. Doctors often notice difficulty breathing of the patient, tension during palpation, Kulenkampf's symptom, increased blood pressure and abrasions on the skin.

In the first few hours, the pain may increase during movement and pressure on the abdominal cavity. But already on the 2-3 day after the bruise, a symptom is likely to occur Shchetkin-Blumberg. It lies in the fact that acute pain in the liver appears immediately after the doctor abruptly removes his hand, stopping pressure on the stomach. Also on the second day there is yellowness of the skin and a rise in temperature to subfebrile indicators.Sometimes at this stage it is no longer possible to cure the disease without dangerous consequences for the body.

With a liver injury, timely diagnosis is extremely important.

Primary diagnosis

When the patient is taken to the emergency room, the doctor examines the color of the skin, measures blood pressure and temperature. Then conducts a thorough palpation of the abdominal cavity. The final step in making a diagnosis is an ultrasound. It will show the location of the hematoma and its size.

X-rays are often also prescribed. The picture shows: if the contours are clear, then everything is in order. If the diaphragm is displaced, the colon and stomach are deformed, and the contours of the liver are blurry, there is a high probability of a hematoma.

One of the diagnostic options is laparoscopy. The procedure is performed under anesthesia: a small incision is made in the abdominal cavity, through which the endoscope is inserted.

Providing emergency assistance

From the pain shock, the victim may well lose consciousness. First thing, bring him to his senses letting ammonia inhale or spraying with cold water. Then strictly follow the instructions:

1. Lay the patient on a flat surface so that no pressure is exerted on the stomach, and the legs are in a half-bent state.
2. Apply on the right side of the abdomen cold, wrapped in cotton cloth.
3. If the person cannot stand the pain until the ambulance arrives, give them a painkiller injection.

If a liver injury is suspected, the patient should not be given any pills, food or even drink.

If there is an open injury in the abdomen, cover it with a clean tissue and attach with a band-aid.

In no case do not adjust the prolapsed internal organs!

Treatment: in the hospital and at home

Depending on the severity of the bruise, the doctor chooses one of three methods of rehabilitation:

• surgical intervention. Prolonged bleeding can only be stopped surgically. In medical practice, ligation of damaged vessels and suturing of small cracks are widely used. In cases where the organ was badly damaged, we will talk about its resection (partial removal);
• drug treatment. If there is no serious blood loss, the doctor will prescribe conservative treatment with the use of hemostatic, healing and cleansing drugs. It is possible to prescribe physiotherapeutic procedures that will accelerate the recovery of soft tissues: magnetic therapy, UHF, electrophoresis;
• physiological recovery. If the damage is very minor and there is no internal bruising, the doctor may simply assign rest at home and bed rest for a few days. Vitamin complexes and hepatoprotectors will not interfere.

In a hospital setting, after liver surgery, a blood transfusion or reinfusion (an infusion of one's own, but filtered) is often prescribed. It is also mandatory to follow a strict diet with the exclusion of alcohol, fatty and fried foods, sweets, citrus fruits.

Treatment with folk remedies for liver injury only exacerbates the problem. After all, every hour counts! And the longer the victim self-medicates, the less likely it is that doctors will be able to return him to a full life.

Complications of liver hematoma

During a moderate impact, a subcapsular hematoma of the liver occurs. It, with proper treatment, has no consequences and does not affect the general condition of the body. If there is sharp pain, it is most likely contusion with rupture of the capsule. Then you need to urgently stop the bleeding so that the liquid in large volumes does not enter the abdominal cavity and does not damage other organs.

When a very severe injury has occurred, but there is no pain in the right hypochondrium, it is possible to develop central hematoma. This is a dangerous injury that has no accompanying symptoms. If timely surgical intervention is not carried out, this type of rupture due to bruising can even lead to death. Other common complications include:

• traumatic cysts;
• compression of the parenchyma;
• abscess formation.

A full recovery after a liver injury is possible only if qualified medical care was provided on time.

Rehabilitation is sometimes delayed up to several months, but, in general, the prognosis for patients is positive.

Liver injury. How to act. Which should never be done.