Blunt abdominal trauma in children: symptoms and treatment. The main signs of an injury to the abdominal organs Damage to the internal organs symptoms

From the anamnesis, the mechanism of injury, the position and state of the body at the time of injury, the direction and force of the blow, the state of the abdominal wall at the time of injury (muscle tension or relaxation), the degree of filling of the gastrointestinal tract with food and fluid preceding the injury, and diseases of the abdominal organs are ascertained from the anamnesis. . Subjectively, patients complain of pain, general weakness, nausea, less often - vomiting. Pain sensations can be in the first hours without a specific localization, throughout the abdomen or with a predominance in the upper or lower sections. Often, pain is associated with rib fractures with concomitant chest injuries (after intercostal blockade with novocaine, these pains disappear). The diffuse nature of pain is typical for rupture of the intestines, mesentery, intracavitary or retroperitoneal bleeding. Localization of pain in the right or left hypochondrium with irradiation to the shoulder of the same name is characteristic of damage to the liver and spleen.

The duration and intensity of pain are important in the diagnosis. If the intensity of pain subsides 2-3 hours after the injury and the victim's condition improves (hemodynamics and respiration normalize), then with a high degree of probability damage to the internal organs can be excluded (in the absence of objective signs of internal bleeding and peritonitis). If the pain progressively increases, becomes diffuse, indications for laparotomy should be set (even in the absence of objective signs of intra-abdominal pathology). It should be remembered that with local injuries of the intestines, patients can walk for a long time, seek medical help on their own, and feel quite satisfactory. However, gradually, increasing with each hour, they develop signs of peritonitis.

Signs of severe shock in the first 1.5-2 hours after injury indicate massive internal bleeding, the source of which is often a rupture of the spleen or liver. At the same time, the pulse becomes threadlike, 130-140 beats per minute, there is a sharp (dead) pallor of the skin and mucous membranes, a decrease in the temperature of the limbs, ears, nose, forehead, and cold sweat appears. Psychomotor agitation (with low or indefinite pressure) confirms the diagnosis and serves as a formidable harbinger of the approaching death of the victim. Patients may complain of increasing tinnitus, dizziness, excruciating thirst, lack of air. Their abdomen is swollen, moderately tense and painful. Only an emergency operation can save the patient.

One of the reliable signs of intra-abdominal damage is the absence of abdominal breathing (or, as they say, the stomach does not participate in the act of breathing). Another reliable sign is a pronounced tension (rigidity) of the abdominal wall. The stronger this tension, the more likely the rupture of the internal organ. With a sharp tension of the abdomen (“like a board”), an intra-abdominal catastrophe is beyond doubt. The absence of noises of intestinal peristalsis (auscultatively) in the first hours after the injury indicates more about intra-abdominal bleeding, in the later stages (2-3 days) "deathly silence" of the abdomen indicates diffuse peritonitis. Symptoms of peritoneal irritation (Shchetkin-Blumberg symptom, etc.) are not specific to abdominal injuries, but they always indicate an acute irritant in the abdominal cavity. The combination of these symptoms with other objective and subjective data significantly increases the reliability of the diagnosis.

Vomiting is a frequent symptom of intra-abdominal damage; in the early period, it is associated with irritation of the vagus nerve, and in the late period, with intoxication of the body. The symptom of "roly-up" should always be alarming - the patient's desire to return to his previous position after turning over on his back, the other side, etc. This phenomenon is based on a sharp increase in pain from irritation of new areas of the peritoneum by the outflowing contents of the gastrointestinal tract or blood (even in small quantities). The appearance of dullness in the sloping areas of the abdomen indicates the presence of fluid in the abdominal cavity. This sign becomes distinct with the accumulation of about 1 liter of fluid. If blood accumulates, then objective signs of massive blood loss should be simultaneously determined. The reliability of the sign increases if the fluid boundary moves when the patient's position changes.

A simple but very informative diagnostic technique is bladder catheterization (especially with concomitant pelvic fractures). A full bladder can obscure the clinical picture of damage to the abdominal organs, the absence of urine can be the cause of intra-abdominal rupture of the bladder, the presence of blood in the urine is a consequence of kidney damage.

Rectal digital examination can also be very informative. This is the only method of direct palpation of the peritoneum. Accumulation of blood or other fluid in the rectovesical cavity in men or in the utero-rectal cavity in women can be directly palpated through the rectum and thus definitively confirm the diagnosis.

An X-ray examination can be of great help in the diagnosis, if the general condition of the patient allows you to turn him on his side or give the body a vertical position. It is possible to detect in the X-ray picture of the abdomen shadows corresponding to fluid in the free abdominal cavity, and enlightenment in the form of a strip, sickle in the subdiaphragmatic spaces or along the lateral surface of the abdomen (when the patient is on his side).

In a laboratory blood test, a decrease in hemoglobin, hematocrit, the number of erythrocytes, and an increase in the number of leukocytes can be established. In the early period, these changes are not typical, but the determination of these indicators in dynamics will undoubtedly be useful for clarifying the diagnosis. Additionally, you can determine the mass of blood and calculate the estimated amount of blood loss from nomograms.

The most reliable method for diagnosing damage to the abdominal organs is a diagnostic laparotomy. Visually determine the nature and extent of intra-abdominal injuries, stop bleeding, restore the integrity of internal organs.

Refusal of this method should be strictly justified, since expectant tactics can be fatal for the patient. The accuracy of diagnosis is significantly increased by laparoscopy and laparocentesis.

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 of great hardness (usually occurs in an accident).
Fall from a great height.

Symptoms of bruises of internal organs

The nature of the damage resulting from bruises depends primarily on the degree of mechanical load and on the area of the body to which this load was directed. For example, if we are talking about a chest injury, pathological changes in the lungs, heart, trachea, etc. are possible. If the main mechanical load falls on the abdomen, the stomach, spleen, liver, kidneys, etc. can be significantly affected. A head injury is often accompanied by a contusion of the brain, the consequences of which can be extremely serious. However, the signs of a concussion are a topic for a separate discussion. And how to recognize bruises of internal organs in other cases?

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

First aid for suspected bruising of internal organs during a fall is to ensure the rest of the victim. It is also necessary to take emergency measures:

Ice or a cold compress should be applied to the bruised area.
To avoid anaphylactic shock, the patient must take an anesthetic.
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 the case, the doctor will prescribe an ECG - 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).

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Bruising of the abdomen is a serious injury that occurs very often. On average, it is up to 4% of the total number of bruises. At the same time, they are classified as one of the most difficult, since the probability of death is high. The statistics of deaths from injury states that abdominal injuries occupy the third position, second only to craniocerebral injuries and in terms of the number of deaths. A bruise can be received during a fall, in an accident, due to natural disasters or as a result of a fight.

Bruising of the anterior abdominal wall in accordance with the international classification of diseases ICD 10 suggests that the classifier code is S30.1. This is an injury to the abdominal wall. Section S30 includes the region of the lower back, pelvis, lower back.

The reasons

Bruises of the anterior abdominal wall in both children and adults are called abdominal by medical staff. They are distinguished by a large number of possible functional disorders, loss of anatomical integrity.

Most often, abdominal injuries in a child and an adult are closed-type injuries, accounting for about 85% of the total number. Open injuries are only 15%, and their main causes include the following:

Fall from a height, taking into account the landing of the abdominal wall on sharp surfaces or elements.
Miscellaneous wounds from firearms or cold (knife).

The consequences of such wounds can be different - bleeding, prolapse of organs. In the presence of the latter, it is not allowed to independently adjust the organs so as not to harm the victim.

There are many more causes of closed blunt abdominal trauma, the main ones include:

Exposure to iatrogenic factors, including therapeutic effects and risks.
Accidents that can happen in the workplace.
Falling on various objects - hard and blunt.
Blows.
Swallowing aggressive chemicals, which include acids and alkalis, and objects with sharp corners.

Symptoms

The main characteristics of abdominal contusion include a large number of severe injuries, the need for postoperative intervention and the presence of subsequent complications, and a high mortality rate.

Signs of injuries of open and closed nature are fundamentally different. These differences include:

receiving mechanism.
The severity of the condition.
Methods for diagnosing damage and subsequent treatment.
End outcome.

All this leads to the fact that the symptoms of damage of a different nature are considered separately. Symptoms may be as follows:

Injury to the abdominal wall. They are characterized by swelling, pain. The pain is aggravated by sneezing and coughing, sudden changes in body position, and stools.
Ruptures of fascia and muscles. The symptoms are basically the same, but the abdominal pain is more pronounced.
Rupture of the small intestine. The main manifestations are vomiting, rapid pulse, a feeling of muscle tension.
Colon rupture. The signs are similar to the trauma described above, but the appearance of shock conditions from pain is more common, and there may also be internal bleeding.
Closed abdominal injuries. A frequent consequence is internal bleeding, fainting, lowering blood pressure, pale skin, rupture of the bladder.
. These are primary and secondary injuries, the latter are usually observed in children. There is severe pain and spontaneous bleeding. There are also symptoms of pain shock.
Injuries of the pancreas. It could be a bruise, concussion or tear.
. There are pain in the lumbar region, blood in the urine, fever.

With any type of damage, there are bruises of soft tissues, bruises.

First aid

Bruising of the abdominal wall necessarily requires primary care. When providing first aid for a bruised abdomen, do the following:

The patient should lie in a comfortable position.
On the stomach you need to put something light and cold.
If there are no visible signs of injury, the symptoms are clarified in order to give the person an anesthetic drug. An injection of ketorolac or a 50% solution of metamizole is allowed. For open injuries, you can use narcotic painkillers, for example, trimeperidine.
After providing primary care, the patient is quickly taken to the nearest medical facility or an ambulance is called.

Features of first aid do not differ depending on how the injury was received, for example, in an accident or when falling from a height.

Diagnosis and treatment

Bruising of the anterior abdominal wall can have different severity. The main difficulty lies in the absence of external wounds and bleeding. Internal blood loss is observed, which worsens the patient's condition and complicates the initial diagnosis. In any case, in the presence of closed and open abdominal injuries, immediate surgical intervention is required.

Therapeutic methods of diagnosis and treatment are selected immediately after the initial diagnosis. They allow you to stop or prevent bleeding of internal organs, the likelihood of peritonitis. Further treatment is often surgical.

Diagnostics assumes the following:

Blood and urine tests.
Electrocardiogram.
X-ray to determine the extent of damage.
Ultrasound examination to determine the presence of bleeding.
CT scan.
Catheterization technique if bladder rupture is suspected.
Laparoscopy.

The treatment of an open and closed abdominal injury is different. Any open wounds necessarily require prompt surgical intervention. Penetrating wounds are treated depending on the injury to the organs. Non-penetrating injuries require surgical intervention, washing the area. After the operation, structures that are not viable are excised and sutures are applied.

Clinical surgery for other injuries involves the following:

Surgical methods of treatment are in demand for ruptures of fascia and muscles, bruises
Large hematomas are opened under local anesthesia. In conclusion, a pressure sterile bandage is applied.
Organ injuries require prompt surgical care and blood transfusions.
Patients are shown bed rest, physiotherapy, infusion therapy.
During the postoperative period, antibiotics and analgesics are prescribed.

Complications and consequences

A contusion of the anterior wall and stomach can have a number of complications:

development of peritonitis.
Internal bleeding, which leads to a sharp deterioration in the condition. Possible death from massive blood loss.
Abdominal sepsis.
Septic shock.
enteral insufficiency.

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.

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 traffic 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.

The reasons

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

Striking the body with a blunt object;
Falling from height;
Falling on a hard object;
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.

Effects

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.