Injuries to the abdomen and abdominal organs

Types of Abdominal Injuries

• Closed abdominal injury is - 85% of abdominal injuries;
• Open abdominal injury - 15% of abdominal injuries.

The most common damage to the spleen and liver . Further prevalence is damage to the kidneys, intestines, pancreas. In case of multiple injuries, the pelvic bones and organs (bladder, ureter, iliac vessels) may be covered

• Pain
• Bloating
• Symptom of peritoneal irritation (absence or significant decrease in intestinal noise, soreness with a sudden weakening of pressure)
• Ecchymosis
• Blood in urine, stool, nasogastric aspirate
• Unexplained hypotension or other signs of hypovolemic shock

None of the signs is an indicator and acute bleeding in the abdominal cavity may not initially appear in painful sensations. Unexplained hypotension ( See the features of hypotension in case of blood loss and the main indicators of the state of the child's body in the article Trauma ) or shock indicate the need for examination for bleeding in the abdominal cavity. Abdominal injuries can lead to significant blood loss. (The pathophysiology of shock with hemorrhagic shock is reflected in the articles Trauma and Shock ). The spleen and liver are highly vascularized organs and bleeding when damaged. Even the accumulation of subcapsular hematomas without perforation can lead to a significant drop in hematocrit . It should also be borne in mind that significant volumes of blood can accumulate in the cup-shaped cavity and retroperitoneal space due to their proximity to the abdominal cavity.

A blunt trauma is usually damage to the whole non-hollow organs of the abdominal cavity (for example, the spleen and liver, and not the small intestine). There are several reasons for this. Firstly, the chest of the child is more elastic, therefore, the probability of fracture of the ribs and, consequently, damage to their internal organs is reduced. Secondly, in children the abdominal muscles are less developed and less adipose tissue and organs are relatively larger in size than in adults. Therefore, a blunt stroke is more easily transmitted to whole organs. Thirdly, in children, the diaphragm is oriented more horizontally, and the spleen and liver lie closer to the anterior lower part of the abdominal cavity.

Damage to the hollow organs of the digestive tract , such as the stomach and intestines, accounts for 5-15% of damages from blunt injuries. There are three mechanisms of damage to the hollow organs of the digestive tract: squeezing between the outer wall of the abdominal cavity and the spine; separation with fixation of the mesentery , with continued movement of the intestinal loop; bursting , when the intestinal section filled with air or liquid is closed on both sides and is affected. Peritonitis develops 6-48 hours after fecal sprinkling or devascularization. Difficulties with the detection of damage to the hollow organs of the digestive tract, the delay in their manifestation necessitates the periodic examination after receiving an injury.

Damage to the duodenum and pancreas is also difficult to diagnose. Spillage of bile and enzymes can lead to pancreatic autolysis and sepsis.

It is not recommended to rely on a physical examination to assess abdominal injuries. According to studies, children with injuries of the abdominal organs do not usually differ from those who have not received such injuries, especially after a short time after receiving an injury. Assessment of organ damage in cases of a significant injury mechanism should be carried out using computed tomography , ultrasound , diagnostic peritoneal lavage, laparoscopy , laparotomy .

A drop in blood pressure is a late sign of the development of a shock condition ( See Trauma and Shock ). A simple way to calculate the lower level of normal systolic blood pressure is 70+ (2 * age in years).

It is necessary to examine the abdomen for the presence of ecchymosis , swelling, fingerprints, penetrations , paradoxical movements, auscultation of intestinal sounds, palpation . If damage to the liver and spleen is suspected, palpation should be minimized to prevent bleeding.

Urinalysis - to detect hematuria and to check related damage to the genitourinary system. Amylase , lipase , alkaline phosphatase may indicate the presence of damage, but normal values ​​do not exclude pathology.

A standard list of laboratory tests includes: complete differential counting of blood cells, analysis of electrolytes, blood urea nitrogen, creatinine, glucose, prothrombin time , partial thromboplastin time, urine, determination of blood group and compatibility.

Diagnostic imaging is carried out after stabilization of the patient's condition as a result of resuscitation. Computed tomography provides 97% accuracy in determining damage to abdominal organs and retroperitoneal (retroperitoneal) lesions. Ultrasound examination shows the presence of damage, but does not determine the nature of the damage, does not reflect the condition of the retroperitoneal region.

In view of the danger of injury and high mortality, diagnosis and treatment should be carried out simultaneously. Hypovolemic shock is the main complication of injuries of the abdominal cavity organs, to which attention must be paid. This is because the most common cause of death from timely undetected causes of abdominal injuries is blood loss. The first measures taken are airway patency and respiratory quality, and the next steps are vascular access and infusion therapy ( See Shock ). It is necessary to check hematocrit and hemoglobins so that blood loss can be estimated. Key indicators of the condition of the body should be monitored frequently. It is necessary to conduct aggressive treatment of orthostatic drop in blood pressure and supine hypotension. If hypodynamic stabilization does not occur after vascular access and resuscitation with solutions (Bolus See Shock ), the traumatologist should perform a diagnostic laparotomy .

One of the specific measures in the treatment of injuries of the abdominal cavity organs is early decompression of the stomach using the nasogastric and orogastric tubes to prevent respiratory failure and decompression of the bladder using a urinary catheter. Before using a urinary catheter, you need to make sure that there is no urethral or urogenital injury, by the presence of blood in the urine.

The appearance of a hernia requires surgical intervention.