Mainly blunt force injuries, such as collision, squeezing, sticks, etc.

Spleen→kidney→small intestine→liver→mesentery (The most common closed abdominal injury is the spleen)

Only limited to the abdominal wall, there may also be visceral injuries at the same time

Mainly peritonitis (Abdominal tenderness, rebound tenderness, and abdominal muscle tension)

Rupture of hollow organs (gastrointestinal tract, biliary tract, bladder) = Abdominal pain, severe peritoneal irritation

Intensity of peritoneal irritation: gastric juice, bile, pancreatic juice It is the most irritating; intestinal juice is the second most irritating, and blood is the lightest.

①The most commonly used ones are chest X-ray and supine abdominal plain X-ray. If necessary, pelvic X-ray can be taken;

② Free gas in the abdominal cavity is evidence of gastrointestinal rupture, and the standing abdominal plain film shows a crescent-shaped shadow under the septum;

③ Retroperitoneal gas accumulation indicates retroperitoneal duodenum (horizontal part of the duodenum) or colorectal perforation;

④In case of retroperitoneal hematoma, the psoas muscle shadow disappears

① Mainly used to diagnose damage to liver, spleen, pancreas, kidney and other parenchymal organs;

②The judgment of cavity organ damage is limited due to the interference of gas in the intestinal cavity

① The patient needs to be moved, so it is only suitable for those whose condition is stable and needs a clear diagnosis;

②It has important diagnostic value for parenchymal organ damage and its scope

① The lavage fluid contains visible blood, bile, gastrointestinal contents or is proven to be urine;

② The red blood cell count exceeds 100×10⁹/L or the white blood cell count exceeds 0.5×10⁹/L under a microscope;

③Amylase exceeds 100 Somogyi units;

④Bacteria were found in the lavage fluid

Those who have severe intra-abdominal gas, are in the second or third trimester of pregnancy, have had previous abdominal surgery or have inflammation and agitation and are unable to cooperate

① Measure blood pressure, pulse rate and respiration every 5 to 30 minutes;

②Check abdominal signs every 30 minutes;

③Measure red blood cell count, hemoglobin and hematocrit every 30 to 60 minutes;

④ Diagnostic abdominal puncture or lavage can be repeated if necessary.

① Do not move the injured casually to avoid aggravating the injury;

②Analgesics are prohibited or used with caution to avoid covering up injuries;

③ Temporarily refrain from drinking to avoid aggravating abdominal cavity contamination in case of gastrointestinal perforation.

① Actively replenish blood volume and prevent and treat shock;

②Inject broad-spectrum antibiotics to prevent and treat possible intra-abdominal infections;

③When there is suspected rupture of hollow organs or obvious abdominal pain, gastrointestinal decompression should be performed

① The general condition tends to worsen, with thirst, irritability, increased pulse rate or Those with increased body temperature and white blood cell count or progressive decrease in red blood cell count;

② Abdominal pain and peritoneal irritation signs progressively worsen or expand in scope;

③ Bowel sounds gradually weaken or disappear or the abdomen gradually bulges;

④ There is free air under the diaphragm, the area of ​​liver dullness shrinks or disappears, or moving dullness appears;

⑤Those who receive active treatment for shock but the condition does not improve or continues to worsen;

⑥Those with gastrointestinal bleeding;

⑦ Abdominal puncture to extract gas, non-coagulated blood, bile, gastrointestinal contents, etc.;

⑧There is obvious tenderness on rectal digital examination.

Liver and spleen → diaphragm, gallbladder → stomach → first section of duodenum → jejunum and ileum → large intestine and its mesentery → pelvic organs → posterior wall of stomach and pancreas → explore second, third and fourth sections of duodenum if necessary.

Hemorrhagic injury → perforated injury; colon → ileum → jejunum → stomach.

Endotracheal intubation anesthesia should be used, and spinal anesthesia is prohibited to avoid a drop in blood pressure.

A midline incision is often used, which allows for rapid abdominal entry, less trauma and less bleeding, and can meet the need for thorough exploration of all parts of the abdominal cavity. The incision can also be extended up and down or added to the side as needed, or even combined with thoracotomy. When the abdomen has an open wound, do not expand the wound to explore the abdominal cavity.

(Tip: The incision for abdominal exploration for peritonitis is: right midline incision. Students can try to understand why)

Accounting for 85%, rupture involving the capsule is the most common type.

Rupture in the peripheral part of the spleen parenchyma

Rupture deep in the spleen parenchyma

Diagnostic abdominal puncture can aspirate non-coagulated blood, which is the gold standard for diagnosis.

Economical, simple and convenient examination method, this is the silver standard for diagnosis

The main measure is absolute bed rest for at least 1 week.

Including splenic rupture repair, splenectomy, etc.

Symptoms include pale complexion, decreased blood pressure, accelerated pulse rate, hemorrhagic shock, etc.

Bile causes peritoneal irritation

After liver rupture, blood may enter the duodenum through the bile duct, causing melena or hematemesis.

Diagnostic abdominal puncture can aspirate non-coagulated bile, which is the gold standard for diagnosis.

Economical, simple and convenient examination method, this is the silver standard for diagnosis

After the pancreas is damaged or ruptured, pancreatic juice can accumulate in the omentum and manifest as obvious upper abdominal tenderness and muscle tension.

After extravasated pancreatic juice enters the abdominal cavity through the omentum or ruptured lesser omentum, diffuse peritonitis and severe abdominal pain may quickly occur.

(Tip: However, for simple blunt trauma to the pancreas, the clinical manifestations are not obvious and the diagnosis is often delayed)

The preferred examination for liver, gallbladder, pancreas, spleen and kidney is abdominal B-ultrasound.

The most valuable and meaningful examination is enhanced CT.

If pancreatic injury is highly suspected or diagnosed, those with obvious peritoneal irritation signs should undergo immediate surgical treatment.

Adequate and effective abdominal and peripheral drainage ensures surgical results and prevents postoperative complications.

The main complications of pancreatic injury are pseudocysts, pancreatic abscesses, and pancreatic fistulas.

Pancreatic pseudocysts often form 3 to 4 weeks after pancreatic trauma or acute pancreatitis. They are mostly located in the body and tail of the pancreas, ranging in size from millimeters to tens of centimeters. They can compress adjacent tissues and cause corresponding symptoms. Perforation of the cyst can cause pancreatic origin. Sexual ascites.

Elevated serum amylase, which is the primary test for pancreatitis.

X-rays showing a blurred outline of the psoas muscle and flower-like changes in the retroperitoneum can be seen on the X-ray. CT showed air bubbles in the retroperitoneum and right anterior general gland.

Crepitus can be palpated in the presacral area, indicating that the air has reached the retrofemoral space in the pelvis.

Peritonitis appears latest and has a high bacterial content, Peritonitis appears later but is more severe

①Except for a few cases with small cracks, light abdominal contamination, and good general condition Some patients may consider primary repair or primary resection and anastomosis; ②Most patients are treated with enterostomy or intestinal external placement first. When the patient's condition improves after 3 to 4 weeks, the fistula can be closed again.

The upper segment of the rectum is above the peritoneal reflection of the pelvic floor, and the lower segment is below the peritoneal reflection. Their appearance after injury is different. If the injury is above peritoneal reflection, the clinical manifestations are basically the same as colon rupture.

above peritoneal reflection

under peritoneal reflection

Blood is discharged from the anus; open wounds on the perineum, sacrococcyx, buttocks, and thighs have excessive discharge of feces; fecal residues are present in the urine; urine is discharged from the anus; after rectal injury, digital rectal examination can reveal rectal There is internal bleeding, and sometimes the rectal rupture can be felt.