Stomach trauma is an injury to the abdomen. Signs and symptoms include abdominal pain, tenderness, stiffness, and bruises on the external abdomen. Complications may include blood loss and infection.
Diagnosis may involve ultrasonography, computed tomography, and peritoneal lavage, and treatments may involve surgery. It is divided into two types of blunt or translucent and may involve damage to the abdominal organs. Stomach to the lower chest can cause spleen or liver injury.
Video Abdominal trauma
Signs and symptoms
Signs and symptoms are not seen in the early days and after a few days the initial pain is visible. Persons injured in motor vehicle crashes may present with "safety belt signs", bruises on the abdomen along the belt's lap area; this sign is associated with a high degree of injury to the abdominal organs. Seat belts can also cause blisters and hematomas; up to 30 percent of people with such signs are related to internal injuries. Early indications of abdominal trauma include nausea, vomiting, blood in the urine, and fever. Injuries may present with abdominal pain, tenderness, distension, or stiffness to the touch, and bowel sound may be reduced or absent. Keeping the abdomen is tensing the abdominal wall muscles to keep the inflamed organ inside the stomach. Pneumoperitoneum, air or gas in the abdominal cavity, may be an indication of rupture of hollow organs. In penetrating the injury, discharge of the contents (protrusion of the internal organs coming out of the wound) may be present.
Injuries associated with intra-abdominal trauma include rib fractures, vertebral fractures, pelvic fractures, and injuries to the abdominal wall.
Maps Abdominal trauma
Cause
Motor vehicle collisions are a common source of abdominal trauma. Seat belts reduce the incidence of injuries such as head injuries and chest injuries, but pose a threat to abdominal organs such as the pancreas and intestines, which may be displaced or suppressed against the spine. Children are particularly vulnerable to stomach injuries from seat belts, because they have a softer abdominal area and seat belts are not designed to fit it. In children, bicycle accidents are also a common cause of stomach injuries, especially when the stomach is struck by the handlebars. Sports injuries can affect abdominal organs such as the spleen and kidneys. Falling and exercise are also frequent mechanisms of stomach injury in children. Stomach injuries can occur due to child abuse and are the second leading cause of death from childhood violence, following traumatic brain injury.
Shot wounds, which have a higher energy than a stab wound, are usually more damaging than the last. The penetrating wound through the peritoneum generates significant damage to the major intra-abdominal structures in approximately 90 percent of cases.
Pathophysiology
Abdominal trauma can be life-threatening because the abdominal organs, especially those in the retroperitoneal space, can release a lot of blood, and that space can store a lot of blood. Solid abdominal organs, such as liver and kidneys, secrete much blood when cut or tear, as do major blood vessels such as the aorta and vena cava. Hollow organs such as the abdomen, while not possible cause shock due to heavy bleeding, pose a serious risk of infection, especially if such injuries are not immediately addressed. Gastrointestinal organs such as the intestines can shed their contents into the abdominal cavity. Hemorrhage and systemic infection are the leading causes of death caused by trauma to the stomach.
One or more of the intra-abdomen organs can be injured in abdominal trauma. The injuries feature is determined partly by an injured organ or organ.
Liver
The liver, the abdominal organ most vulnerable to all forms of injury due to its size and location (in the right quadrant above the abdomen), injured about five percent of all people hospitalized for trauma. Liver injury poses a serious risk for shock because the liver tissue is smooth and has a large blood supply and capacity. In children, the liver is the most commonly injured stomach organ. The liver may be torn or infected, and the hematoma may develop. This can be leaked, usually without serious consequences. If seriously injured, the liver may cause exsanguination (bleeding to death), requiring emergency surgery to stop the bleeding.
Spleen
The spleen is the most common cause of massive bleeding in abdominal blunt trauma to solid organs. The spleen is the organ most often injured. The spleen is the second most commonly injured intra-abdominal organ in children. Spleen laseration may be associated with hematoma. Due to the bleeding ability of the spleen, a splitting spleen can be life-threatening, resulting in shock. However, unlike liver, penetrating trauma to the spleen, pancreas and kidneys do not present as a threat of immediate shock unless they tear the main blood vessels supplying organs, such as the kidney arteries. The lower left rib fracture is associated with lymphatic laceration in 20 percent of cases.
Pancreas
The pancreas can be injured in an abdominal trauma, for example by lacerations or bruises. Pancreatic injuries, most commonly caused by bicycle accidents (mainly by impact with the handlebars) in children and vehicle accidents in adults, usually occur in isolation in children and are accompanied by other injuries in adults. Indications that the pancreas is injured include enlargement and presence of fluid around the pancreas.
Kidney
The kidneys may also be injured; they are rather but not fully protected by the ribs. Laseration and renal contusions may also occur. Kidney injury, a common finding in children with abdominal blunt trauma, may be associated with bloody urine. Renal laseration may be associated with urinoma or leakage of urine into the abdomen. A shattered kidney is one with several lacerations and fragmentation related kidney tissue.
Bowel
The small intestine takes most of the stomach and is likely to be damaged in penetrating the wound. The intestine may be hollow. The gas in the abdominal cavity seen in CT is understood as a diagnostic mark of intestinal perforation; Intra-abdominal air, however, can also be caused by pneumothorax (air in the pleural cavity outside the lungs that have escaped the respiratory system) or pneumomediastinum (air in the mediastinum, the center of the chest cavity). Injury may not be detected on CT. Bowel injuries can be associated with complications such as infection, abscesses, intestinal obstruction, and fistula formation. Bowel perforation requires surgery.
Diagnosis
One study found that ten percent of polytrauma patients who had no clinical signs of stomach injury had evidence of such injury using radiological imaging. The diagnostic techniques used include CT scan, ultrasound, and X-ray. X-rays can help determine the path of the penetrating object and find foreign objects remaining in the wound, but may not help in blunt trauma. Diagnostic peritoneum lavage is a controversial technique but can be used to detect injuries to the abdominal organs: a catheter is placed in the peritoneal cavity, and if fluid is present, it is aspirated and examined for blood or evidence of organ rupture. If this does not reveal evidence of injury, sterile saline is infused into the cavity and evacuated and examined for blood or other ingredients. While peritoneal lavage is an accurate way to test for bleeding, it carries the risk of injuring the abdominal organs, may be difficult, and may lead to unnecessary surgery; so most have been replaced by ultrasound in Europe and North America. Ultrasound can detect fluids such as blood or gastrointestinal contents in the abdominal cavity, and it is a noninvasive and relatively safe procedure for the patient. CT scan is a preferred technique for people who do not have a direct risk of shock, but because ultrasound can be performed right in the emergency room, the latter is recommended for people who are not stable enough to move to a CT scan. However, people with abdominal trauma often require CT scans for other trauma (eg, head or chest CT); in this case the abdominal CT can be performed at the same time without wasting time in patient care. Diagnostic laparoscopy or exploratory laparotomy may also be performed if other diagnostic methods do not produce conclusive results.
CT
CT is only able to detect 76% of hollow condensed wounds and patients who have negative scanning results should be frequently observed and reexamined if they deteriorate. However, CT has proven useful in screening patients with certain forms of abdominal trauma to avoid unnecessary laparotomy, which can significantly increase the cost and length of hospitalization. A meta-analysis of CT use in penetrating trauma to the abdomen shows sensitivity, specificity and accuracy & gt; = 95%, with 85% PPV and 98% NPV. This suggests that CT is excellent for avoiding unnecessary laparotomy but should be supplemented by other clinical criteria to determine the need for surgical exploration (23.37 positive likelihood ratio, negative likelihood ratio 0.05).
Classification
Abdominal trauma is divided into blunt and penetrating types. While penetration of abdominal trauma (PAT) is usually diagnosed based on clinical signs, the diagnosis of blunt abdominal trauma is more likely to be postponed or disappear altogether because clinical signs are less clear. Blunt injuries dominate in rural areas, while more frequent penetration in urban settings. The penetrating trauma is subdivided into stab wounds and gunshot wounds, which require different treatment methods.
Treatment
Initial treatment involves sufficient patient stabilization to ensure adequate airway, breathing and circulation, and identify other injuries. Surgery may be needed to repair injured organs. Surgical exploration is necessary for people with penetrating injuries and signs of peritonitis or shock. Laparotomy is often performed on blunted abdominal trauma, and is indispensable if abdominal injuries cause large and potentially lethal bleeding. The ultimate goal is to stop the source of the bleeding before moving on to definitive findings and correct the injury it finds. Due to its time-sensitive nature, the procedure also emphasizes the feasibility of gaining access and controlling bleeding, thus supporting long-line insertion. Intra-abdominal injury is also often successfully treated without surgery because there is little benefit shown if there is no known active bleeding or possible infection. The use of CT scans allows care providers to use fewer operations as they can identify conservative managed injuries and override other injuries that will require surgery. Depending on the injury, a patient may or may not require intensive care.
Prognosis
If a stomach injury is not diagnosed immediately, a worse outcome is attributed. Delayed treatment is associated with very high morbidity and mortality if gastrointestinal perforations are involved.
Epidemiology
Most deaths from trauma to the stomach can be prevented; Abdominal trauma is one of the most common causes of preventable and traumatized death.
References
Bibliography
- Feliciano, David V.; Mattox, Kenneth L.; Moore, Ernest J (2012). Trauma, Seventh Edition (Trauma (Moore)) . McGraw-Hill Professional. ISBN 978-0-07-166351-9.
- Fitzgerald, J.E.F.; Larvin, Mike (2009). "Chapter 15: Tummy Trauma Management". In Baker, Qassim; Aldoori, Munther. Clinical Surgery: A Practical Guide . Press CRC. pp. 192-204. ISBN: 9781444109627.
External links
Source of the article : Wikipedia
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