Stupid injury of a stomach – the closed traumatic injury of abdominal organs and zabryushinny space. Belongs to the category of life-threatening damages, quite often is complicated by sharp peritonitis and hemorrhagic shock. Falling from height, blow in a stomach or a waist, road accident, industrial or natural disaster can become the reason of a trauma. The diagnosis is exposed on the basis of the clinical symptoms given to ultrasonography, KT, a X-ray analysis, a laparoscopy and other researches. Treatment is surgical.
Stupid injury of a stomach
Stupid injury of a stomach – an internal injury, located in an abdominal cavity and zabryushinny space, at preservation of integrity of integuments of a forward belly wall, lumbar area and side departments of a stomach. Poses a threat for the patient's life, at the same time external signs of heavy damage are absent or are minimum (integuments are whole, there are no visible deformations), existence of a light interval is characteristic (the condition of the victim right after a trauma can remain satisfactory).
Everything listed in some cases becomes the reason of the late address of patients to experts, complicates first-aid treatment and creates certain difficulties in the course of diagnostics. Meanwhile, the probability of a happy end directly depends on a timely initiation of treatment. At development of serious condition efficiency of medical assistance considerably decreases, and the probability of a lethal outcome and emergence of dangerous complications sharply increases.
Reasons of development and classification of a stupid injury of stomach
The powerful concentrated blow to the area of a forward belly wall and side departments of a stomach becomes an immediate cause of damage, is more rare – to the area of a waist. Usually at the time of influence of a muscle of a stomach are in more or less weakened state – it creates favorable conditions for blow "transmission" deep into of fabrics. The similar mechanism of a trauma can be observed during the criminal incidents (punch or a leg), car accidents, falling from the big height, natural or industrial disasters.
Intensive traumatic impact and simultaneous emergence of several damages is characteristic of the majority of the listed incidents. Combinations of the closed stomach injury to a basin change, fractures of edges, fractures of bones of the top and lower extremities, spinal fracture, ChMT and wounds of various areas are possible. Existence of several damages makes heavier a condition of the patient, provokes bystry development of traumatic shock and increases probability of massive blood loss.
Taking into account features of damage to traumatology allocate the following types of a stupid injury of stomach:
- Without internal injury. Include bruises, ruptures of fastion and muscles of a belly wall in this group.
- With injury of abdominal organs. Here refer injury of a spleen, injury of a liver, a vnutribryushinny rupture of a bladder, a rupture of a small and large intestine.
- With damage of the bodies located outside an abdominal cavity. Include a vnebryushinny rupture of a bladder, injury of a kidney, injury of a pancreas and ruptures of some departments of a large intestine in this group.
- With intra belly bleeding. Similar injuries can arise at injury of a liver, spleen, vessels of an epiploon and bryzheyka of intestines.
- With threat of early development of peritonitis. Here carry injuries with a rupture of hollow bodies (a stomach, intestines).
- With simultaneous damage of hollow and parenchymatous bodies.
The stupid injury of a stomach can be isolated (one body is damaged, for example, only a liver or only a small intestine), multiple (several bodies are damaged, for example, a spleen and a thick gut) or combined (defeat of several bodies and systems, for example, a rupture of a bladder and a change of a basin or injury of a pancreas and a fracture of a shoulder is observed).
Symptoms of a stupid injury of stomach
In the anamnesis the characteristic trauma comes to light, the patient complains of belly-ache. Absence of pain is not the basis for an exception of the diagnosis of a stupid injury of stomach: in a light interval pain happens insignificant, in an erectile phase of shock the victim can underestimate weight of the state and not notice pain; in the presence of other damages (for example, fractures of edges or bones of extremities) belly-ache can pass into the background and not be realized because of an intensive pain syndrome in other part of a body; in a torpedo phase of shock of the complaint can be absent because of decrease in sensitivity, depression and indifference of the patient, consciousness violations etc.
In the field of a forward belly wall, the lower edges, side departments of a stomach and a waist hematomas and grazes are sometimes visible. Muscles of a forward belly wall are strained (it is necessary to consider that at exhaustion, an atrophy of muscles, and also a thickening of a fatty layer and fatty regeneration of muscles tension can be weak, hardly noticeable). Morbidity at a stomach palpation comes to light, at intra belly damages positive symptoms of irritation of a peritoneum are defined.
In the presence of 500 and more than a ml. the blood which expired from the damaged vessel or parenchymatous body can define obtusion of a sound at stomach percussion. At an auskultation weakening of a vermicular movement is noted. From other symptoms there can be nausea, vomiting, absence or changes of a chair, blood in urine, the speeded-up painful urination etc. Among the general nespefitsichesky signs – increase of pulse, decrease HELL and increase in a shock index.
In some cases characteristic symptoms allow the traumatologist to suspect damage of this or that body even before carrying out tool researches. So, at ruptures of a small and thick intestine there is an extending, amplifying belly-ache, nausea and vomiting, traumatic shock can develop. At the same time at ruptures of a thick gut tension of a belly wall is expressed more brightly, symptoms of intra belly bleeding quite often come to light.
At a liver injury usually there is plentiful internal bleeding. The condition of the patient quickly worsens, develops gipovolemichesky shock, consciousness loss is possible. If the contact with the patient is kept, the complaints to pain in the right podreberye irradiating in right to a nadplechya come to light. Pressure is reduced, the breath and pulse which are speeded up skin pale. At injury of a spleen in some cases symptoms of massive internal bleeding are also observed, however pain disturbs not on the right, and at the left. Sometimes (at a subcapsular gap) the condition of the patient in the first days or even weeks can remain satisfactory.
At injury of a pancreas the victim complains of sharp pain in subspoon area, tension of muscles of a belly wall and an abdominal distension is noted. At injury of a kidney there is a makrogematuriya and pain in a waist. At vnebryushinny ruptures of a bladder hypostasis of a crotch and false desires on an urination comes to light, at vnutribryushinny injuries of a bladder frequent false desires, pain in the bottom of a stomach, an abdominal distension and weakening of a vermicular movement are observed.
Diagnostics and treatment of a stupid injury of stomach
Injured with suspicion of the closed stomach injury immediately bring to medical institution, appoint blood tests and urine, define a blood type and a Rhesus factor. For the rest the scheme of inspection is made individually. For an exception of intra belly bleeding (including subcapsular) and estimates of a condition of internals use ultrasonography, KT, MCKT. If these researches are inaccessible, at suspicion on a rupture of hollow bodies apply a X-ray analysis of an abdominal cavity.
At suspicion on injury of a bladder carry out a kateterization, if necessary carry out the ascending tsistografiya. The most exact and effective method of diagnostics of injuries of abdominal organs is the laparoscopy allowing to estimate visually a condition of internals, extent of their destruction, a source and intensity of bleeding and, thus, most accurately to define indications to surgical intervention and tactics of expeditious treatment.
Treatment of bruises, ruptures of fastion and muscles of a belly wall conservative. At damage of hollow and parenchymatous bodies the emergency operation – an ushivaniye, a resection or removal of body is shown. Intervention is carried out against the background of intensive antishock actions: blood transfusion and blood substitutes, artificial respiration, stimulation of warm activity, control and stimulation of a diuresis etc. In the postoperative period continue intensive therapy, appoint antibiotics and analgetics.