Stomach injuries – extensive group of the heavy damages in most cases posing a threat for the patient's life. Can be as closed, and open. Opened most often arise owing to knife wounds though also other reasons are possible (falling on a sharp object, a gunshot wound). Falling from height, road accidents, industrial accidents etc. become the reason of the closed injuries usually. Weight of damage at the opened and closed injury of a stomach can vary, but the special problem is represented by the closed injuries. In this case due to the lack of a wound and external bleeding, and also because of the traumatic shock accompanying such damages or serious condition of the patient quite often there are difficulties at a stage of primary diagnostics. At suspicion of an injury of a stomach urgent delivery of the patient in specialized medical institution is necessary. Treatment is usually surgical.
Stomach injury – the closed or open damage of area of a stomach both with violation, and without violation of integrity of internals. Any injury of a stomach has to be considered as the serious damage demanding immediate inspection and treatment in the conditions of a hospital as in such cases there is a high risk of development of bleeding and/or peritonitis posing direct hazard to life of the patient.
Classification of injuries of stomach
In domestic traumatology the following classification of injuries of stomach is used. The closed stomach injuries:
- Without internal injury – bruises of a belly wall.
- With an internal injury outside an abdominal cavity. Thus the bladder, kidneys and some departments of a large intestine are more often injured.
- With injury of abdominal organs.
- With intra belly bleeding. Arise at a trauma of a bryzheyka of intestines, vessels of an epiploon, a spleen and liver.
- With threat of bystry development of peritonitis. Here stomach injuries with a rupture of hollow bodies – a stomach and intestines belong.
- With the combined damages of parenchymatous and hollow bodies.
Open injuries of a stomach:
- Not getting.
- Getting without internal injury.
- Getting with an internal injury.
Besides, injuries of a stomach can be isolated (one damage), multiple (several damages, for example, multiple wounds in a stomach) and combined (combined with damage of other bodies and systems).
Open injuries of a stomach
Open damage can be put with firearms, cold weapon or a secondary shell.
Cut wounds are given by a knife. Cut wounds have the form of the line and rather big extent. Smooth edges. Quite often such injuries of a stomach are followed by considerable external bleeding owing to crossing of a large number of vessels. At extensive damages the eventration – a state at which the abdominal organ drops out in a wound is possible.
Chipped wounds can be given by a thin knife, a bayonet, a narrow stiletto, scissors, a pricker or a table fork. Chipped wounds differ in the thin wound channel, usually poorly bleed. At the same time the deep water of the wound channel and serious internal injuries is possible. Pose a serious threat as the patient, seeing a small wound, can underestimate danger and ask too late for the help.
Chopped wounds arise at blow by the axe. They big with rather uneven edges, with plentiful bleeding and extensive damage of soft fabrics.
Lacerations are formed during attack of animals or damage by mechanisms owing to a production trauma (for example, at contact with the fan blade). These are the heaviest, extensive and traumatic wounds. Fabrics and bodies in such cases have multiple damages with crushes and gaps. Besides, as a rule, lacerations are followed by strong pollution of fabrics.
Bullet wounds also concern to group of especially heavy damages as are followed not only by formation of the wound channel, but also a fabric contusion at distance approximately by 30 times exceeding diameter of a bullet or pellet. Because of a contusion of fabric and bodies stretch, contract, stratified or broken off. Besides, the stomach injury at a gunshot wound can be implicit as entrance openings in 50% of cases settle down not on a forward belly wall, and in other places (for example, on one side or in a waist).
At damage by a secondary shell (a metal detail, a splinter flew down etc.) there are fragmentary hurt wounds. Such injury of a stomach is characteristic of industrial accidents and road accidents.
The closed (stupid) injuries of a stomach
The bruise of a belly wall is followed by pain and local hypostasis of field of damage. Hemorrhages and grazes are possible. Pain amplifies at the act of defecation, sneezing, cough and change of position of a body.
The rupture of muscles and fastion of a belly wall is shown by the same symptoms, however, pain in this case stronger therefore development of dynamic intestinal impassability owing to reflex paresis of intestines is possible. Additional inspection is necessary for an exception of ruptures of parenchymatous and hollow bodies.
The rupture of a small intestine usually arises at direct stroke to the area of a stomach. Is followed by the amplifying and extending belly-ache, tension of muscles of a belly wall, increase of pulse and vomiting. Development of traumatic shock is possible.
The rupture of a thick gut on symptomatology reminds ruptures of a small intestine, however at the same time tension of a belly wall and symptoms of intra belly bleeding quite often comes to light. Shock develops more often than at ruptures of a small intestine.
Injury of a liver arises at a stomach injury rather often. Both subcapsular cracks or gaps, and a full separation of separate parts of a liver are possible. Such injury of a liver in most cases is followed by plentiful internal bleeding. A condition of the patient heavy, consciousness loss is possible. At the kept consciousness the patient complains of pains in the right podreberye which can irradiate to the right supraclavicular area. Skin is pale, pulse and breath the speeded-up, arterial pressure is reduced. Signs of traumatic shock.
Injury of a spleen – the most widespread damage at a stupid injury of a stomach, makes 30% of total number of injuries with violation of integrity of abdominal organs. Can be primary (symptoms appear right after a trauma) or secondary (symptoms arise in several days or even weeks). Secondary ruptures of a spleen are usually observed at children.
At small gaps bleeding stops because of formation of a blood clot. At large damages there is plentiful internal bleeding with a blood congestion in an abdominal cavity (). Serious condition, shock, pressure drop, increase of pulse and breath. The patient is disturbed by pains in the left podreberye, irradiation in the left shoulder is possible. Pain decreases in situation on the left side with the legs bent and tightened to a stomach.
Injuries of a pancreas. Usually arise at severe injuries of a stomach and are quite often combined with damage of other bodies (intestines, a liver, kidneys and a spleen). Pancreas concussion, its bruise or a gap is possible. The patient complains of sharp pains in subspoon area. Serious condition, a stomach it is blown up, muscles of a forward belly wall are strained, pulse is speeded up, arterial pressure is reduced.
Injury of a kidney at a stupid injury of a stomach meets rather seldom. It is connected with a location of the body lying in zabryushinny space and from all directions surrounded with other bodies and fabrics. At a bruise or concussion pain in lumbar area, a makrogematuriya (release of urine with blood) and temperature increase develops. Heavier injuries of kidneys (a razmozzheniye or gaps) usually arise at a severe injury of a stomach and are combined with damage of other bodies. A state of shock, pain, tension of muscles in lumbar area and a podreberye on side of the injured kidney, falling of arterial pressure, tachycardia is characteristic.
The rupture of a bladder can be vnebryushinny or vnutribryushinny. The stupid injury of a stomach at the filled bladder becomes the reason. False desires on an urination, pain and hypostasis of a crotch are characteristic of a vnebryushinny gap. Allocation of small amount of urine with blood is possible.
The Vnutribryushinny rupture of a bladder is followed by pain in the bottom of a stomach and frequent false desires on an urination. Because of the urine which streamed in an abdominal cavity peritonitis develops. The stomach is soft, moderately painful at a palpation, swelling and weakening of an intestinal vermicular movement is noted.
Diagnosis of an injury of stomach
Suspicion of an injury of a stomach is the indication to immediate delivery of the patient in a hospital for diagnostics and further treatment. In such situation it is extremely important to estimate as soon as possible the nature of damages and first of all – to reveal bleeding which can threaten the patient's life.
At receipt in all cases blood tests and urine are surely made, definition of a blood type and Rhesus factor is carried out. Other methods of a research are chosen individually taking into account clinical manifestations and weight of a condition of the patient.
With the advent of modern, more exact methods of a research the X-ray analysis of an abdominal cavity at a stomach injury partially lost the diagnostic value. Nevertheless, it can be applied to identification of ruptures of hollow bodies. Carrying out a radiological research is also shown at gunshot wounds (for definition of the location of foreign matters – bullets or fraction) and at suspicion on the accompanying change of a basin or injury of a thorax.
Available and informative method of a research is the ultrasonography allowing to diagnose intra belly bleeding and to find subcapsular damages of bodies which can become a bleeding source in the future.
In the presence of the corresponding equipment for inspection of the patient with an injury of a stomach use a computer tomography which allows to study in detail structure and a condition of internals, having revealed even small damages and insignificant bleeding.
At suspicion on a rupture of a bladder the kateterization is shown – confirmation of the diagnosis is the small amount of the bloody urine which is emitted through a catheter. In doubtful cases carrying out the ascending tsistografiya at which availability of X-ray contrast solution in okolopuzyrny cellulose is found is necessary.
One of the most effective methods of diagnostics at an injury of a stomach is the laparoscopy. The endoscope via which it is possible to see directly internals is entered into an abdominal cavity through a small section, to estimate extent of their confirmation and to accurately define indications to operation. In some cases the laparoscopy is not only a diagnostic, but also medical technique by means of which it is possible to stop bleeding and to remove blood from an abdominal cavity.
Treatment of injuries of stomach
Open wounds are the indication to the emergency operation. At the superficial wounds which are not getting into an abdominal cavity usual primary surgical processing with washing of a cavity of a wound, excision of the impractical and strongly polluted fabrics and suture is carried out. At the getting wounds the nature of surgery depends on existence of damages of any bodies.
Bruises of a belly wall, and also ruptures of muscles and fastion are treated conservatively. The bed rest, cold and physical therapy is appointed. At large hematomas the puncture or opening and drainage of a hematoma can be necessary.
Ruptures of parenchymatous and hollow bodies, and also intra belly bleedings are the indication to the emergency operation. Under the general anesthesia the median laparotomy is carried out. Through a wide section the surgeon carefully examines abdominal organs, reveals and eliminates damages. In the postoperative period at an injury of a stomach analgetics are appointed, antibiotic treatment is carried out. In need of the course of operation and in the postoperative period blood transfusion and blood substitutes is carried out.
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