Causes and severity factors
Closed abdominal trauma generally occurs as a result of blunt force to the anterior abdominal wall or lower thorax. The main causes include motor vehicle accidents, falls, heavy blows, or crush injuries leading to crush syndrome.
The severity of the sustained injuries depends on several key factors:
- The force and vector of the traumatic agent.
- The condition of the abdominal wall at the moment of impact, including its elasticity, thickness of the adipose layer, and tone of the muscular framework.
- The degree of filling of hollow organs. If the stomach or bladder is full, the risk of rupture from a blunt impact increases manifold.
Injuries are classified into parenchymal organ trauma (leading to bleeding) and hollow organ trauma (causing peritonitis). Combinations of these are frequent, as are polytrauma associated with traumatic brain injuries and fractures. It is important to remember that rupture of the liver or spleen is often provoked by sharp fragments of the lower ribs.
Parenchymal organ injury
In injuries of the liver, spleen, and mesenteric vessels, the clinical picture of intra-abdominal bleeding comes to the fore, comprising signs of blood loss, peritoneal irritation, and traumatic shock.
Patients complain of increasing weakness, dizziness, and dull abdominal pain. Objectively, decreased blood pressure (hypotension) and a rapid pulse of low volume (tachycardia) are recorded. The abdomen is sunken, painful, and tense upon palpation, and abrasions may be present on the abdominal wall. Percussion in dependent areas reveals a dull sound, indicating the accumulation of free blood.
A specific sign of bleeding is the «tumbler» sign (Vanka-Vstanka symptom). Due to blood pooling and irritation of the diaphragmatic peritoneum, the patient experiences sharp pain under the diaphragm when attempting to lie down, forcing them to constantly return to a semi-sitting position.
An insidious variant of injury is the two-phase (subcapsular) rupture. Initially, a hematoma forms under the organ capsule while the patient's general condition remains satisfactory. Hours or even days later, the accumulated blood ruptures the capsule, causing sharp pain, massive hemorrhage, and profound collapse.
Diagnosis includes abdominal paracentesis (including the wandering catheter method) and laparoscopy. Treatment is strictly surgical—emergency laparotomy involving liver resection or splenectomy.
Hollow organ injury
Rupture of the stomach, intestines, gallbladder, or urinary bladder leads to the immediate leakage of their contents (gastric juice, bile, feces, urine) into the free peritoneal cavity. This exerts a strong irritating effect on the peritoneum and causes its infection, leading to the development of peritonitis.
The leading symptom is acute, severe pain occurring at the exact moment of trauma. Initially, its localization depends on the injured organ: with rupture of the stomach or duodenum, the upper half of the abdomen hurts; with bladder rupture, the lower regions. As inflammation develops, the pain spreads across the entire abdomen. Dyspeptic disorders (nausea, vomiting), tachycardia, and signs of shock are observed.
Objective examination reveals:
- Pronounced tension of the abdominal wall muscles.
- Positive Shchetkin-Blumberg sign.
- Increased pain upon abdominal percussion.
- Disappearance or reduction of liver dullness (due to gas accumulation under the diaphragm).
- In bladder injury—urination disorders and absence of urine upon catheterization.
The diagnosis is confirmed by radiography (searching for free gas—pneumoperitoneum) or laparoscopy.
Treatment: Surgery is performed on an emergency basis. Stages include organ revision, surgical management (suturing the rupture, resection of a crushed bowel, or cholecystectomy), thorough debridement (aspirating contents and flushing with antiseptics), and drainage. For bladder injuries, a suprapubic fistula or catheter is additionally placed for urinary diversion.
To remember the bleeding symptom, think of the children's toy «tumbler» (Vanka-Vstanka): due to diaphragmatic irritation from the escaped blood, the patient cannot lie horizontally and upon any attempt to lie down reflexively returns to a forced semi-sitting position.
Class and exam questions
Why is a full bladder or stomach more likely to rupture upon impact?
A full hollow organ loses its elasticity. During blunt impact to the abdomen, the pressure inside the organ rises sharply, easily leading to the rupture of its walls.
What is a two-phase splenic rupture?
This is an injury where a concealed subcapsular hematoma forms initially, causing no acute clinical manifestations. Several hours or days later, the capsule bursts, and blood pours into the abdominal cavity all at once, causing shock.
What does the disappearance of liver dullness during percussion indicate?
This symptom indicates the accumulation of free gas under the diaphragmatic dome. Gas escapes into the abdominal cavity as a result of perforation or rupture of a hollow viscus (e.g., the stomach).
What else to study on this topic
- Technique of abdominal paracentesis using a wandering catheter
- Features of retroperitoneal drainage in duodenal injury
- Radiological picture of pneumoperitoneum
- Mechanism of traumatic shock development in massive blood loss
Master the entire topic in the "General Surgery" course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on «Closed abdominal trauma» and 3,335 more pages of the subject
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 70 video lessons on the subject
Other topics in "CHAPTER 10. GENERAL ISSUES IN TRAUMATOLOGY"
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.