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Infected abdominal wound ICD 10. Blunt abdominal trauma, open abdominal injuries

RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Archive - Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2007 (Order No. 764)

Injury to other intra-abdominal organs (S36.8)

general information

Short description

Abdominal injuries- isolated or complex damage to the integrity of the skin, internal organs belly.

Protocol code: E-025 "Blunt abdominal trauma, open damage belly"
Profile: emergency

Purpose of the stage: stopping ongoing bleeding; restoration of circulating blood volume; prevention of the spread of infection; prevention of stopping effective blood circulation; urgent hospitalization of the victim in a specialized hospital.

ICD-10 code(s):

S36 Abdominal trauma

S36.0 Injury to the spleen

S36.1 Injury to liver or gallbladder

S36.2 Trauma to the pancreas

S36.3 Stomach trauma

S36.4 Small intestinal injury

S36.5 Colon trauma

S36.6 Rectal injury

S36.7 Injury to multiple intra-abdominal organs

S36.8 Injury to other intra-abdominal organs

Classification

In relation to the skin:

1. Closed abdominal injuries.

2. Open abdominal injuries.

By volume of damage:

1. Isolated damage.

2. Combined injuries.

By number of wounds:

1. Singles.

2. Multiple.

According to the nature of the wound channel:

1. Tangents.

2. End-to-end.

3. Blind.

In relation to the peritoneum:

Non-penetrating:

1. With damage to the tissues of the abdominal wall.

2. Extraperitoneal damage to the intestines, kidneys, ureters, Bladder, pancreas.

Penetrating:

1. Without damage to internal organs.

2. With damage to the abdominal organs:

Parenchymal (liver, spleen);

Hollow (stomach, intestines, bladder);

With combined damage to hollow and parenchymal organs.

3. With damage to the retroperitoneal organs:

Parenchymal (pancreas, kidneys);

Hollow ( duodenum, colon, ureter, bladder).

4. With damage to the abdominal organs and retroperitoneal space.

By type of wounding weapon:

1. Firearms.

2. Non-firearms.

Isolated injury- abdominal trauma, in which there is one injury.

Multiple abdominal injuries- abdominal injuries, in which several organs of the abdominal cavity are damaged.

Combined injuries- abdominal injuries, in which damage is localized in several areas of the body (head, neck, chest, pelvis, spine, limbs).

Thoracoabdominal injuries- combined injury to the chest and abdomen, in which damage to the diaphragm is obligatory.

Combined injuries- injuries when the human body is exposed to several damaging factors (mechanical, thermal, etc.).

Diagnostics

Diagnostic criteria for abdominal injury:

1. A victim with damage to the abdominal organs tries to lie still - often on his back or on his side with his legs bent, and when he tries to change his position, the victim returns to his previous position (Vanka-stand-up symptom).

2. The victim’s face is haggard, with a pained expression; constant desire to drink liquids.

3. The level of consciousness can be different: from clear consciousness to stupor and coma.

4. Tachycardia and the level of blood pressure decrease are more significant, the more severe the injury and blood loss.

5. The frequency, rhythm and depth of breathing are impaired parallel to the severity of the injury.

6. The tongue is usually dry, covered with a white or brown coating.

7. The anterior abdominal wall either does not participate in the act of breathing, or its movements are limited.

8. Palpation reveals varying degrees of rigidity of the abdominal muscles (muscular defence).

9. Carefully, without aggression, signs of peritoneal irritation (Blumberg's symptom) are determined.

10. Percussion determines the area of greatest pain, the presence of fluid (hemoperitoneum, hydroperitoneum) or free gas in the abdominal cavity (pneumoperitoneum).

11. Auscultation reveals reduced intestinal motility or its complete absence.

There are two groups of victims with blunt abdominal trauma:

1. With a clinical picture of acute blood loss.

2. With symptoms of peritonitis with increasing signs of endogenous intoxication.

Features of diagnosing non-penetrating abdominal wounds:

1. Satisfactory condition of the victim.

2. Local changes - swelling, muscle tension, pain in the wound area.

3. Injuries leading to the formation of a hematoma in the preperitoneal tissue may be accompanied by symptoms of peritoneal irritation.

4. For wounds of the intestines or stomach - symptoms of rapidly developing peritonitis.

5. If the injury is non-penetrating, the possibility of direct damage to retroperitoneal organs cannot be ruled out.

Non-penetrating wounds

Non-penetrating abdominal wounds are characterized by a satisfactory condition of the victim.
Local changes are manifested by swelling, muscle tension, and pain in the wound area.

Injuries leading to the formation of a hematoma in the preperitoneal tissue may be accompanied by symptoms of peritoneal irritation.

If the injury is non-penetrating, the possibility of direct damage to retroperitoneal organs cannot be ruled out.

Penetrating wounds

The clinical picture of penetrating abdominal wounds is determined by which organs (parenchymal or hollow) are damaged.

Isolated damage to parenchymal organs occurs rarely; a combination of damage to hollow and parenchymal organs is more often observed.

The clinical picture is determined by the predominance of one of two syndromes: acute massive blood loss and peritonitis.

From a tactical decision point of view prehospital stage all wounds of the anterior abdominal wall, lumbar region and in the region of the costal arches should be regarded as penetrating into the abdominal cavity.

The penetrating nature of the injury is beyond doubt when it is determined absolute signs penetrating trauma: eventration of abdominal organs, leakage of gastric or intestinal contents, urine or bile.

Injuries to the stomach and intestines are characterized by symptoms of rapidly developing peritonitis.

For wounds of the liver, spleen and abdominal vessels - clinical manifestation of acute blood loss.

TO early symptoms relate:

Tension of the anterior abdominal wall;

Signs of peritoneal irritation;

Paleness of the skin;

Tachycardia and arterial hypotension.

Late symptoms include:

Bloating;

Dry and coated tongue;

Thready pulse;

A sharp decrease in blood pressure.

Damage to hollow organs

Due to a closed abdominal injury, all parts can be damaged digestive tract, peritoneal part of the bladder, gall bladder.

In addition to ruptures, tears, and the formation of subserous hematomas, damage to the mesentery is typical, leading to heavy bleeding into the peritoneal cavity.

The more distal the intestinal rupture, the more aggressive the peritonitis. Clinical manifestation is based on signs of peritoneal irritation.

The leakage of biologically active fluids (blood, bile, urine, intestinal and gastric contents) into the abdominal cavity gives the pain a diffuse character without clear localization.

Over time, the intensity of the pain increases, and signs of irritation of the peritoneum become clear. Increasing tachycardia and a decrease in blood pressure indicate possible blood loss into the free abdominal cavity.

Joyce's symptom helps to distinguish retroperitoneal hematoma and hemorrhage at the root of the mesentery from accumulation of blood in the abdominal cavity: dullness in the lateral abdomen does not shift when the victim is transferred from the supine position to the lateral position.

Damage to parenchymal organs

Parenchymal organs are damaged more often in closed injuries than hollow ones. The spleen is damaged more often than other organs. As a result of a closed abdominal injury, organs located retroperitoneally - the pancreas and kidneys - can be damaged. When the peritoneum covering these organs is damaged, clinical picture, similar to liver and spleen injuries.

The liver and spleen have a dense capsule, under which, some time after injury (hours, days), blood can accumulate to form a subcapsular hematoma. Subsequently, with any physical stress, the capsule ruptures, the hematoma empties into the abdominal cavity and intense, sometimes fatal, bleeding occurs.

Clinical manifestations damage to parenchymal organs are based on general signs of trauma and intra-abdominal bleeding. Usually, in the projection of the damaged organ, local pain with dubious signs of irritation of the peritoneum is determined. The general condition of the victims is serious, consciousness is impaired. The skin is pale; severe blood loss is characterized by “marbling” of the skin of the extremities. There is pronounced tachycardia and a decrease in blood pressure up to collapse.

When combined closed damage abdominal organs with rib fractures and pelvic bones diagnosis becomes much more difficult.

With cranioabdominal injuries, when the victim is unconscious, it is almost impossible to make a clinical diagnosis.

Features of diagnosing penetrating abdominal wounds:

1. Eventration of the abdominal organs, leakage of gastric or intestinal contents, urine or bile.

2. With the appearance of a significant amount of gas in the abdominal cavity, a symptom of disappearance (by percussion) of hepatic dullness may be detected.

3. Increasing tachycardia, decreased blood pressure - blood loss into the free abdominal cavity.

General signs of acute intra-abdominal bleeding:

Complaints of weakness, dizziness;

Low-intensity abdominal pain;

Pallor skin and mucous membranes;

Marbling of the limbs with severe blood loss;

Increased tachycardia;

Decline blood pressure(control of the Algover index in dynamics is necessary).

Local signs acute intra-abdominal bleeding:

Moderate localized pain and tenderness;

Positive Shchetkin-Blumberg symptom;

Dullness in the sloping parts of the abdomen.

Suspicion of injury to the abdominal organs should always arise when the severity of the victim’s condition cannot be explained by other localizations of damage!

List of basic and additional diagnostic measures:

1. Establishing the forced position of the victim.

2. Evaluation appearance the victim.

3. Clarification of the severity of the condition and assessment of the level of consciousness.

4. Determination of blood pressure and heart rate parameters over time.

5. Determination of breathing parameters, frequency breathing movements in dynamics.

6. Inspection of the surface of the tongue and oral cavity.

7. In case of an open abdominal injury, clarify the location of the wound, determine the presence of discharge from the wound and the fact of prolapse of internal organs.

8. Checking the participation of the abdominal wall in the act of breathing.

9. Defining the contours of the abdomen.

10. Palpation detection of rigidity of the muscles of the anterior abdominal wall and phenomena of peritoneal irritation.

11. Listening to intestinal motility (at least 1 minute).

12. Percussion detection of the presence of liquid or free gas in the abdominal cavity.

13. Control of bladder function and urine output (hematuria!).

*in an emergency situation, the victim is examined without removing the previously applied bandage and clothing.

*sometimes an isolated injury to the abdominal wall can manifest damage to internal organs.

*the presence of dysuric phenomena is observed not only with damage to the bladder and urethra, but also with damage to the abdominal organs and retroperitoneal space.

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Treatment

Tactics of rendering medical care

Urgent Care:

1. Prevention or elimination of asphyxia - cleaning the mouth and nose from blood clots and foreign particles.

2. Application of an aseptic protective bandage in the presence of a wound to the abdominal wall.

3. In the case of a closed abdominal injury, if there are signs of deepening hemorrhagic shock Profuse intraperitoneal bleeding should be suspected - with two palms, forcefully press the anterior abdominal wall towards the spine; The assistant first pushes a dense object under one palm, then under the second palm, the area corresponding to the front surface of the abdomen (plywood, board, book), with constant pressure, after which the said object is circularly fixed to the body with belts*.

4. When eventrating 1-3 loops of intestine or omentum through a wound of the abdominal wall, these organs are not reduced into the abdominal cavity, but are covered with several layers of a damp sterile bandage, which are circularly fixed to the body without excessive tightening (danger of ischemia and traumatization of eventrated organs!).

5. In case of extensive eventration of the abdominal organs, you should (after introducing 2 ml of 0.005% fentanyl solution with 1 ml of 0.1% atropine solution) expand and lift the edges of the abdominal wall defect with both hands, after which the assistant should carefully, at least partially, immerse the prolapsed organs into the abdominal cavity; then an aseptic bandage is applied, which is circularly fixed to the body with bandages without excessive tension*.

6. In the case of prolapse of a loop of intestine through a small defect of the abdominal wall and its subsequent strangulation, the strangulation should be eliminated by a small dissection of the existing abdominal wall defect (after administration of 2 ml of 0.005% fentanyl solution with 1 ml of 0.1% atropine solution).

7. If there is a defect in the wall of a prolapsed organ, the said organ should be slightly pulled into the wound, limited with aseptic napkins and fixed to the abdominal wall to avoid its subsequent immersion in the abdominal cavity.

8. Pain relief: 2 ml of 0.005% fentanyl solution with 1 ml of 0.1% atropine solution.

9. Intravenous administration crystalloid and colloid solutions to replenish the bcc (if blood pressure is not determined, then the infusion rate should be 300-500 ml/min; in case of shock of I-II degree, up to 800-1000 ml of polyionic solutions are administered intravenously; for more severe disorders blood circulation should be added to the IV injection of dextrans or hydroxyethyl starch at a dose of 5-10 ml/kg until blood pressure stabilizes at 90-100 mm Hg).

10. In case of low hemodynamic parameters, despite rehydration, administration of vasopressor and glucocorticoid drugs in order to gain time and prevent cardiac arrest on the way to the hospital: dopamine 200 mg in 400 ml of plasma replacement solution i.v. in quick drops, prednisone up to 300 mg IV.

11. Introduction sedatives in case of psychomotor agitation.

12. With the development of acute respiratory failure inhaling oxygen through a mask.

13. Tracheal intubation and mechanical ventilation for apnea, respiratory rhythm disturbances, decompensated acute respiratory failure (RR less than 12 or more than 30), traumatic shock of the 3rd degree.

14. In case of stopping effective blood circulation - resuscitation measures.

15. Transport immobilization (according to indications).

16. Transportation of victims is carried out in a horizontal position to a specialized hospital.

*compression of the abdomen increases intra-abdominal pressure, which prevents further release of blood from the great vessels and vessels of damaged parenchymal organs into the abdominal cavity.

*in the case of extensive eventration of intra-abdominal organs, one should be wary not of infection of the abdominal cavity, but of decompensated shock, which will certainly develop during transportation: constant tension of the mesentery (irritation of nerve trunks and compression of blood vessels!), drying out and hyperirritation of a huge area of eventrated organs.

*in this situation, one should be wary not of infection of the abdominal cavity, but of the consequences of strangulation - disruption of the blood supply, innervation and trophism of the strangulated part, as well as the adductor and efferent segment of the intestine, which in the future may require resection of a significant part of the intestine.

Replenishment of blood loss:- traumatic shock of the third degree.

Information

Sources and literature

Protocols for diagnosis and treatment of diseases of the Ministry of Health of the Republic of Kazakhstan (Order No. 764 of December 28, 2007)
1. 1. Disaster surgery. HA. Musalatov. Moscow, “Medicine”, 1998 2. Guide to emergency medical care. Bagnenko S.F., Vertkin A.L., Miroshnichenko A.G., Khabutia M.Sh. GEOTAR-Media, 2006 3. First aid in emergency critical conditions. I.F. Epiphany. St. Petersburg, “Hippocrates”, 2003 4. Diagnosis and treatment of wounds. Ed. SOUTH. Shaposhnikova. Moscow, “Medicine”, 1984 5. Abdominal injuries. SOUTH. Shaposhnikov et al. Moscow, “Medicine”, 1986 6. First aid for emergency critical conditions. I.F. Epiphany. St. Petersburg, “Hippocrates”, 2003 7. Feliciano, Mattox, Moore. Trauma. McGraw-Hill Company, 2004 8. Greaves, Porter, Ryan. Trauma Care Manual. London, 2001 9. Henderson. Emergency medicine. Texas, 2006 10. Order of the Minister of Health of the Republic of Kazakhstan dated December 22, 2004 No. 883 “On approval of the List of essential (vital) medicines.” 11. Order of the Minister of Health of the Republic of Kazakhstan dated November 30, 2005 No. 542 “On introducing amendments and additions to the order of the Ministry of Health of the Republic of Kazakhstan dated December 7, 2004 No. 854 “On approval of the Instructions for the formation of the List of essential (vital) medicines.”

Information

Head of the Department of Emergency and Emergency Medical Care, Internal Medicine No. 2, Kazakh National Medical University named after. S.D. Asfendiyarova - Doctor of Medical Sciences, Professor Turlanov K.M.

Employees of the Department of Ambulance and Emergency Medical Care, Internal Medicine No. 2 of the Kazakh National Medical University named after. S.D. Asfendiyarova: candidate of medical sciences, associate professor Vodnev V.P.; candidate of medical sciences, associate professor Dyusembayev B.K.; Candidate of Medical Sciences, Associate Professor Akhmetova G.D.; candidate of medical sciences, associate professor Bedelbaeva G.G.; Almukhambetov M.K.; Lozhkin A.A.; Madenov N.N.

Head of the Department of Emergency Medicine of the Almaty State Institute for Advanced Medical Studies - Candidate of Medical Sciences, Associate Professor Rakhimbaev R.S.

Employees of the Department of Emergency Medicine of the Almaty State Institute for Advanced Medical Studies: Candidate of Medical Sciences, Associate Professor Silachev Yu.Ya.; Volkova N.V.; Khairulin R.Z.; Sedenko V.A.

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Chain in classification:

1Classes of ICD-10
2 Injuries, poisoning and some other consequences of external causes

Diagnosis with code S00-T98 includes 21 qualifying diagnoses (ICD-10 headings):

The diagnosis does not include:
- birth trauma (P10-P15)
- obstetric trauma (O70-O71)

Explanation of the disease with code S00-T98 in the MBK-10 directory:

In this class, the section labeled S is used for coding various types injuries related to a specific area of the body, and the section with the letter T is for coding multiple injuries and injuries to individual unspecified parts of the body, as well as poisoning and some other consequences of external causes.

In cases where the heading indicates the multiple nature of the injury, the conjunction “c” means simultaneous damage to both named areas of the body, and the conjunction “and” means both one and both areas.

The principle of multiple injury coding should be applied as widely as possible. Combined rubrics for multiple injuries are given for use when there is insufficient detail of the nature of each individual injury or for primary statistical developments, when it is more convenient to register a single code; in other cases, each component of the injury should be coded separately. In addition, it is necessary to take into account the rules for coding morbidity and mortality set out in Volume 2.

The blocks of section S, as well as the headings T00-T14 and T90-T98, include injuries that, at the level of three-digit headings, are classified by type as follows:

Superficial trauma, including:
abrasion
water bubble (non-thermal)
contusion, including bruising, bruising and hematoma
trauma from a superficial foreign body (splinter) without a large open wound
insect bite (non-venomous)
Open wound, including:
bitten
sliced
torn
chopped:
. NOS
. with (penetrating) foreign body

Fracture, including:
. closed: . splintered). depressed). speaker). split). incomplete). impacted) with or without delayed healing. linear). marching). simple ) . with displacement) of the epiphysis). helical
. with dislocation
. with offset

Fracture:
. open: . difficult ) . infected). gunshot) with or without delayed healing. with a pinpoint wound). with a foreign body)
Excluded: fracture: . pathological (M84.4) . with osteoporosis (M80.-) . stress (M84.3) malunion (M84.0) nonunion [false joint] (M84.1)

Dislocations, sprains and overstrain of the capsular-ligamentous apparatus of the joint, including:
separation)
gap)
stretch)
overvoltage)
traumatic: ) joint (capsule) ligament
. hemarthrosis)
. tear)
. subluxation)
. gap)

Nerve and spinal cord injury, including:
complete or incomplete spinal cord injury
disruption of the integrity of nerves and spinal cord
traumatic:
. nerve transection
. hematomyelia
. paralysis (transient)
. paraplegia
. quadriplegia

Damage to blood vessels, including:
separation)
dissection)
tear)
traumatic: ) blood vessels
. aneurysm or fistula (arteriovenous)
. arterial hematoma)
. gap)

Damage to muscles and tendons, including:
separation)
dissection)
tear) muscles and tendons
traumatic rupture)

Crushing [crushing]
Traumatic amputation
Internal organ injury, including:
from a blast wave)
bruise)
concussion injuries)
crushing)
dissection)
traumatic (s): ) internal organs
. hematoma)
. puncture)
. gap)
. tear)
Other and unspecified injuries

This class contains the following blocks:

S00-S09 Head injuries
S10-S19 Neck injuries
S20-S29 Chest injuries
S30-S39 Injuries to the abdomen, lower back, lumbar spine and pelvis
S40-S49 Injuries of the shoulder girdle and shoulder
S50-S59 Elbow and forearm injuries
S60-S69 Wrist and hand injuries
S70-S79 Injuries of the hip joint and thigh
S80-S89 Knee and lower leg injuries
S90-S99 Injuries to the ankle and foot area
T00-T07 Injuries involving multiple areas of the body
T08-T14 Injury to an unspecified part of the trunk, limb or area of the body
T15-T19 Consequences of foreign body penetration through natural orifices
T20-T32 Thermal and chemical burns
T33-T35 Frostbite
T36-T50 Poisoning by drugs, medications and biological substances
T51-T65 Toxic effects of substances, mainly for non-medical purposes
T66-T78 Other and unspecified effects of external causes
T79 Some early complications of injury
T80-T88 Complications of surgical and therapeutic interventions, not elsewhere classified
T90-T98 Consequences of injuries, poisoning and other effects of external causes

In most cases, this is due to a complication after surgery, which is called “Seroma”. Of course, after the operation there should be no compactions or formations in the suture area. 2. Long-term seroma can lead to the formation of some kind of mucous membrane, both on the skin-fat flap, which is detached, and on the anterior abdominal wall. The invention relates to medicine, in particular to the treatment of a “minor” postoperative complication - seroma in large and giant postoperative ventral hernias.

Local complications in the area postoperative wound are not so rare, but fortunately they mostly occur without serious consequences. Often there is pain and redness in the area of the postoperative suture. You need to understand how to properly treat sutures after surgery. Wetting seams may not have anything to do with inflammation. In some cases, a so-called seroma develops in the postoperative area, which means a local accumulation of serous fluid.

If the development of seroma is suspected, on the second or third day after surgery, serous discharge from the wound is evacuated once (less often twice), after which the formation of seroma ends. Very often, patients who have undergone surgery are interested in the question of how to care for postoperative sutures so that they do not become inflamed and heal as quickly as possible.

The invention relates to surgery and can be used for the treatment of seroma. One of the complications encountered during ventroplasty is the accumulation of serous fluid in the area of the surgical wound, which is defined by surgeons as “seroma”.

In practice, there are numerous ways to prevent and treat this complication, which consists of striving to eliminate wound cavities and pockets in the ventroplasty area. Plastic surgery of the anterior abdominal wall is a highly effective intervention, but in certain conditions it can lead to the development of dangerous complications.

However, this period may expand with development local complications, which, ultimately, is fraught with the development of hypostatic pneumonia and even pulmonary embolism. Thus, during liposuction in the lateral abdomen and flank areas, pressure on these areas leads to a clear movement of wound exudate into the main wound through the channels formed by the cannula.

The seam becomes wet after surgery

Due to the fact that the wound surfaces separated by liquid remain mobile and do not grow together, the drained cavity is slowly filled with granulations. However, it is very common to see a lump under the suture after surgery.

This is a formation in the cavity that is filled with lymph. To avoid this, it is necessary to treat the area of the postoperative wound with an antiseptic. In this case, it is best to use a water-based antiseptic rather than an alcohol-based one. A more serious complication if a seal forms under the suture after surgery is a fistula. IN medical practice fistula occurs as a result of suppuration of scars after surgery.

As a result of this operation, the man developed a huge growth on his abdomen, which reached 20-30 cm in size. As a rule, seroma does not hurt.

Alphabetical index of diseases according to ICD-10. Part 3

Only in in rare cases When the volume of serrous fluid is large, pain may occur. Quite often, because of this, seroma remains unrecognized for a long time.

Removal of inguinal hernia - all the features of the procedure - Complications

In 90% of cases this is enough. In some particularly stubborn cases, 10, 15, and sometimes more punctures may be required. In this case, the surgeon installs a drainage with active aspiration. At the same time it is necessary to carry out drug treatment. Such prevention methods can significantly reduce the risk of seroma formation.

Early complications of postoperative wounds

During the operation, it turned out that in the lower abdomen there was no fusion of subcutaneous fat with the muscles of the abdominal wall. As a result, an isolated cavity with a small amount of serous fluid was formed. Such a cavity can exist for a very long time. In some cases (trauma, hypothermia, etc.), the amount of fluid may increase, which is perceived by patients as an enlargement of the abdomen.

The long-term existence of seroma leads to the fact that this cavity never heals, which leads to some mobility of the skin relative to the anterior abdominal wall. 3. Long-term seroma can lead to deformation of the skin-fat flap, thinning of the subcutaneous fat, which will ultimately worsen the aesthetic result of the operation. Early complications of postoperative wounds are in the form of seroma, ligature fistulas, dehiscence of wound edges, wound suppuration, infiltration, hematoma and bleeding.

In this case, the wound must be covered sterile bandage, which is moistened with an antiseptic solution. All early complications of postoperative wounds are accompanied by pain syndromes, the person develops insomnia, mental disturbances and may require repeated surgery. And almost everywhere it’s the same: complaints, clinical picture, surgery, possible complications after her. Well, almost everything. It is written, in most cases, as in a textbook for students and doctors.

The development of such a postoperative complication is more typical for fat people with excessively developed adipose tissue. The resulting seroma externally manifests itself as the release of a straw-colored liquid from the postoperative wound. First of all, the most important thing in the postoperative period is keeping the wound clean. IN medical institutions wounds are treated with skin antiseptics.

The purpose of the present invention is to improve the efficiency surgical treatment postoperative ventral hernias through effective treatment of wound postoperative complications. This complication occurs in up to 30% of patients who have undergone surgery with large detachment of subcutaneous tissue. Treatment of complications takes a long time, which prolongs rehabilitation period and worsens the results of surgical treatment.

The main reason for the development of seroma is the formation during the operation of extensive wound surfaces that do not fit tightly to each other and shift during movements. Its formation is due to the fact that during the operation the lymphatic capillaries are crossed, and the lymph flowing from them accumulates under the loose subcutaneous fat. Liposuction through the wall of the main wound (during abdominoplasty) can also play an important role in the development of seroma.

Memo for the patient after surgery

Is there a need to stay in intensive care?

Very often, patients ask me whether or not it is necessary to be in the intensive care unit; many even insist on being under intensive observation. In general, the answer can be given as follows: in patients at high risk postoperative complications from the heart, lungs, nervous system Staying in the intensive care unit is advisable. In patients who are not burdened concomitant diseases, in the case when general anesthesia It passes calmly and the patient tolerates it well; a stay in the intensive care unit can take several hours.

When is general health restored?

On the 2nd day after surgery, I recommend carefully sitting down in bed and getting up. If you feel dizzy, it is better to stay in bed. If your health allows, you should move carefully. On the second day after surgery, you can independently visit the toilet and move around the ward. By 3-4 days, your health is almost completely restored.

How bothersome can pain be after surgery?

At rest, patients usually note discomfort. There may be pain when moving. It can be harsh with sudden movements.

How is pain relief performed after surgery?

On the first day after surgery, narcotic drugs are administered every few hours. On days 2-3, I prescribe strong painkillers, usually in the afternoon and evening.

Can I use my own painkillers?

Yes, you can. The only exception is aspirin. If you took it before the operation, you can continue; if not, then you cannot take it without my prescription. Aspirin is a drug that causes increased bleeding and this can lead to bruises.

What can you eat after surgery?

There are no dietary restrictions caused by the intervention itself. If you have chronic diseases such as gallstones and chronic cholecystitis, and you followed a diet, then, of course, you must continue to follow it. You should definitely follow a diet if you have diabetes. In this case, I believe there should be no relaxation.

When is the drain removed?

The drainage is removed 3-4 days after surgery. The Unovac drain can be removed 3-4 weeks after surgery.

Why does fluid accumulate in the wound?

During the operation, the lymphatic pathways are crossed, and therefore the lymph enters directly into the wound.

International Classification of Diseases

It takes time for the tissues to gradually begin to eliminate the fluid on their own, so punctures can be performed after surgery.

What to do if fluid accumulates after discharge?

I usually recommend seeing your local doctor or nurse for a puncture (recommendations for these are usually on the back of the statement). If this procedure is not feasible or the patient can come for dressings - I prescribe dressings in our department.

How to treat a wound after surgery?

There is no need to specially treat the scar after discharge. To soften the scar or remove crusts, you can use baby cream. To reduce the scar, you can use Contractubex gel.

What is fenestration (“hole”)?

In case of abundant accumulation of fluid in the wound (more than 200 ml per day), or the presence of infection, open drainage is recommended - making a hole in the skin of the axillary area. The accumulated liquid is evacuated outside. For 3-4 weeks, it is necessary to keep the armpit area clean and place a clean (not necessarily sterile) diaper.

Postoperative seroma

Seromas are accumulations of serous effusion in subcutaneous tissue sutured wound in the form of a cavity.

In obese patients, especially when in the process surgical intervention severe damage or detachment of subcutaneous fatty tissue from the muscular aponeurotic layer occurs over a large area; a cavity filled with straw-colored liquid may form in the wound. This is associated with major trauma to soft tissues, including lymphatic vessels.

Postoperative suture seroma - clinical picture

Clinically, seroma manifests itself in the fact that 2-3 days after surgery, patients begin to complain of discomfort in the wound area, sometimes minor pain appears, and periodically low-grade fever. Upon palpation, a practically painless infiltrate over the aponeurosis is determined.

The presence of infiltrate in the wound area is absolute indication for its revision: 1-2 skin sutures are removed above the infiltrate, the edges of the wound are pulled apart with tweezers or a clamp, and the wound contents are evacuated.

Causes and treatment of wound suppuration after surgery

The seroma cavity is drained with a rubber strip for 1-2 days. In order to prevent the development of wound infection, antibiotic therapy is prescribed for a short time.

careful suturing of the abdominal wall wound without leaving pockets;
various types of vacuum drainage, including active aspiration of wound discharge according to Redon (accordion drainage);
apply a pressure bandage or weight to the wound area (a bag of sand) for several hours.

The incidence of septic complications of postoperative wounds is largely determined by the presence of initial infection.

Groups of surgical interventions

In order to objectively predict postoperative wound infection, a number of authors (G.K. Vandyaev, 1985; M.I. Kuzin et al. 1986) divide all surgical interventions into four groups: “clean”, “conditionally clean”, “contaminated”, “ dirty".

“Clean” operations are not accompanied by opening of hollow organs, when there is no real danger of wound contamination: uncomplicated hernia repairs, removal of benign soft tissue tumors, selective proximal vagotomy, etc. The frequency of septic complications is 1.5-2%.

“Conditionally clean” operations are accompanied by opening the lumen of hollow organs, but their contents are not poured into the abdominal cavity: gastric resection, vagotomy with drainage operations, and the application of biliodigestive anastomoses. The incidence of septic complications is 4-10%.

“Contaminated” operations involve dissection of inflamed tissue (without the presence of pus) or are accompanied by the opening of hollow organs when their contents enter the abdominal cavity. The incidence of septic complications is 15-20%.

“Dirty” operations are surgical interventions for penetrating (open) abdominal injuries, perforation of hollow organs and purulent-destructive processes. The incidence of septic complications is 20-40%.

It should be noted that purulent-inflammatory complications of wounds in the immediate postoperative period are more often associated with contact or lymphogenous spread of infection, and in the later period - with implantation contamination (suture material).

Septic complications of a wound can be detected in the serous-infiltrative stage (infiltrate) or purulent-necrotic.

If there is an infiltrate, the wound is inspected with a button probe, patients are prescribed intensive antibacterial therapy, UHF, electrophoresis with dimexide, and a short block is performed with a solution of novocaine with antibiotics.

In the purulent-septic stage of the process, the wound is opened wide, washed with a solution of furatsilin or chlorhexidine, and subjected to ultrasonic cavitation, then drained with tubular drainages, through which fractional lavage of the wound cavity is performed or tampons with hypertonic (10%) sodium chloride solution are introduced. Intensive antibacterial and detoxification therapy is carried out.

Principles for the prevention of postoperative septic complications:

establishment in surgical hospital and the operating unit of an operating mode that ensures the prevention of the development of hospital infection: elimination (suppression) of sources, blockade (break) of the epidemiological chain of transmission (paths of penetration) of hospital infection;
carrying out activities that increase the body’s resistance to infection;
proper equipment of the hospital and operating unit;
regular monitoring of compliance with asepsis and antiseptics at all workplaces;
prophylactic use of antiseptics and/or antibiotics: immediately before surgery, immediately after surgery, and then, according to indications, antibiotics are administered for another 2-3 days (L.F. Mozheiko, L.K. Malevich, 2000).

Postoperative eventration is the depressurization of the abdominal cavity and the exit of the viscera beyond its limits due to an acutely developed defect in the peritoneum and the muscular aponeurotic layer of the abdominal wall. The frequency of such complications ranges from 0.5 to 2%. The time frame for the development of eventrations is 5-10 days after surgery.

There are four degrees of eventration (O.B. Milonov, K.D. Toskin, V.V. Zhebrovsky, 1990):

degree - subcutaneous eventration - separation of all layers of the abdominal wall, except the skin.

degree - partial eventration - complete separation of all layers of the abdominal wall, but the internal organs remain within the abdominal cavity.

degree - complete eventration - complete separation of all layers of the abdominal wall, the wound is filled with viscera.

degree - true eventration (evisceration) - exit of the viscera beyond the wound of the abdominal wall.

Factors predisposing to eventration:

Are common: old age, obesity, diabetes mellitus, cachexia, hypovitaminosis, liver cirrhosis, anemia, hypoproteinemia, long-term administration of heparin, corticosteroids, dextrans in the postoperative period;

Local: peritonitis, wound suppuration, inflammatory changes in the tissues being stitched, technical errors when suturing the wound.

Producing (realizing) factors of eventrations: cough, vomiting, intestinal paresis, motor agitation, portal hypertension.

Eventration of internal organs

Based on the above, all events of internal organs must be divided into two groups: aseptic and septic. Naturally, such a division is very arbitrary, but this is what primarily determines the tactics of treating this pathology.

Aseptic eventration refers to the divergence of the edges of the wound and the release of the insides, when there is no peritonitis and obvious signs of wound infection.

Septic eventration is associated with primary wound suppuration or secondary infection due to the development of peritonitis.

Subcutaneous eventrations are treated conservatively:

strict bed rest for 14-15 days;
in order to prevent dehiscence, tighten the edges of the skin wound with long strips of adhesive plaster, which weakens the tension;
applying a tight bandage to the abdomen (elastic belt, tight bandaging);
stimulation of intestinal function, ensuring stool regulation;
correction of metabolism, especially protein and carbohydrate, vitamin balance;
stimulation of regeneration.

In the aseptic form of partial eventration, patients undergo surgical treatment: inspection of the wound, thorough washing with antiseptic solutions, suturing through all layers of the abdominal wall. A figure-eight detachable stitch is preferred.

In the septic form of partial eventration, patients undergo conservative treatment, which includes thorough sanitation of the infected wound cavity, targeted antibacterial therapy, detoxification, increasing nonspecific and immunological reactivity and resistance of the body, the introduction of plastic and energy substrates (solutions of amino acids, glucose) and vitamins.

Sanitation purulent cavity It is performed by opening it wide (if necessary, removing all sutures), excision of necrotic tissue, removing ligatures applied during the first operation, and thoroughly washing the wound with weak antiseptic solutions (chlorhexidine).

In the aseptic form of complete eventration, patients undergo urgent surgical intervention. Intensive preoperative preparation is carried out for 2-3 hours. Under endotracheal anesthesia with mechanical ventilation against the background of muscle relaxants, thorough sanitation of prolapsed organs (omentum, loops) is carried out small intestine), carefully reposition them into the abdominal cavity. The latter is washed with a warm solution of furatsilin and dried using an electric suction. The edges of the wound are excised sparingly: necrotic tissue and old ligatures. 1-2 microirrigators are inserted into the abdominal cavity by puncture. The wound is sutured with figure-of-eight sutures through all layers, departing 2-3 cm from the edges. It is recommended to use unloading sutures.

In order to reduce intra-abdominal pressure Early stimulation of intestinal motility is carried out, if necessary, closed decompression of the stomach and small intestine, long-term epidural blockade at the level of the upper lumbar segments, and electrical stimulation.

Similar tactics are used during true eventration.

Stage III and IV events into a purulent wound are accompanied by widespread peritonitis, so treatment is primarily aimed at stopping the infectious process in the abdominal cavity and wound.

In the vast majority of cases, patients undergo surgical treatment - laparostomy.

Combined anesthesia: epidural anesthesia at the level of the lower thoracic segments + endotracheal inhalation anesthesia with mechanical ventilation against the background of muscle relaxants.

After standard treatment and lining of the surgical field, careful sanitation of the prolapsed organs, expansion of the wound by removing all sutures, excision of necrotic tissue, sanitation of the abdominal cavity and wound are carried out. For long-term decompression, nasogastric splinting of the small intestine and drainage of the stomach are performed, and, if necessary, splinting of the large intestine. Microirrigators are introduced into the lateral sections of the abdomen and pelvis for fractional administration of antibiotics or antiseptics. The loops of the small intestine, after they have been emptied and washed, are covered with an omentum, and the top is covered with large gauze napkins, generously moistened with antiseptic solutions.

Having retreated 3-4 cm from the edge of the wound, thick synthetic ligatures are passed through all layers, fixing the napkins in the wound of the abdominal wall. Flow or fractional washing of the wound with antiseptic solutions is established.

Intestinal decompression is maintained for 3-4 days, epidural anesthesia, which provides an analgesic effect and relaxation of the abdominal muscles, for 1-9 days. On the 5-6th day, if it was possible to stop peritonitis and wound infection, the edges of the wound are brought together simultaneously or in 2-3 steps, ensuring healing. The sutures are removed approximately 16-20 days after the edges of the wound come together.

Based on general and local predisposing factors of eventration, as well as the mechanisms that implement it, the development of this complication can be predicted in a number of patients.

Therefore, preventing events of the abdominal organs is a completely feasible task. The prevention of this complication is based on measures aimed at increasing the body’s resistance to surgical trauma, reducing the stress response, stabilizing metabolism and stimulating regenerative processes.

It is necessary to strictly control the prescription of drugs that inhibit reparative reactions (glucocorticoids, heparin, fraxiparin, polyglucin, rheopolyglucin, etc.).

Postoperative complications

Local complications. Complications in the area of the surgical wound include bleeding, hematoma, infiltration, suppuration of the wound, separation of its edges with prolapse of the viscera (eventration), ligature fistula, and seroma.

Bleeding can occur as a result of insufficient hemostasis during surgery, slipping of the ligature from the vessel, or a blood clotting disorder. Stopping bleeding is carried out by known methods of final hemostasis (cold application to the wound, tamponade, ligation, hemostatic drugs), and repeated surgical intervention performed for this purpose.

A hematoma forms in tissues from blood coming from a bleeding vessel. It dissolves under the influence of heat (compress, ultraviolet irradiation (UVR)), and is removed by puncture or surgery.

Infiltrate- this is the impregnation of tissues with exudate at a distance of 5-10 cm from the edges of the wound. The reasons are infection of the wound, traumatization of subcutaneous fat with the formation of areas of necrosis and hematomas, inadequate drainage of the wound in obese patients, use for sutures on subcutaneous fat material with high tissue reactivity. Clinical signs of infiltration appear on the 3rd - 6th day after surgery: pain, swelling and hyperemia of the edges of the wound, where a painful compaction without clear contours is palpated, deterioration general condition, increased body temperature, the appearance of other symptoms of inflammation and intoxication. Resorption of the infiltrate is also possible under the influence of heat, so physiotherapy is used.

Wound suppuration develops for the same reasons as infiltration, but the inflammatory phenomena are more pronounced. Clinical signs appear towards the end of the first - beginning of the second day after surgery and progress in the following days. Within several days the patient's condition approaches septic. If the wound suppurates, you need to remove the stitches, separate its edges, release the pus, sanitize and drain the wound.

Eventration- protrusion of organs through a surgical wound - may occur due to various reasons: due to deterioration of tissue regeneration (with hypoproteinemia, anemia, vitamin deficiency, exhaustion), insufficiently strong tissue suturing, wound suppuration, a sharp and prolonged increase in intra-abdominal pressure (with flatulence, vomiting, cough, etc.).

The clinical picture depends on the degree of eventration. Prolapse of the viscera most often occurs on the 7-10th day or earlier with a sharp increase in intra-abdominal pressure and is manifested by the divergence of the edges of the wound, the exit of organs through it, which can result in the development of their inflammation and necrosis, intestinal obstruction, peritonitis.

During eventration, the wound should be covered with a sterile bandage moistened with an antiseptic solution. In an operating room under general anesthesia the surgical field and prolapsed organs are treated with antiseptic solutions; the latter are straightened, the edges of the wound are tightened with strips of plaster or strong suture material and reinforced with tight abdominal bandaging and a tight bandage. The patient is prescribed strict bed rest for 2 weeks and stimulation of intestinal activity.

Ligature fistula appears as a result of infection of non-absorbable suture material(especially silk) or individual intolerance by the macroorganism to suture material. An abscess forms around the material, which opens in the area postoperative scar.

The clinical manifestation of a ligature fistula is the presence of a fistula tract through which pus is released with pieces of the ligature.

In case of multiple fistulas, as well as a long-lasting single fistula, an operation is performed - excision of the postoperative scar with the fistula tract. After removing the ligature, the wound heals quickly.

Seroma- accumulation of serous fluid - occurs due to the intersection of lymphatic capillaries, the lymph of which collects in the cavity between the subcutaneous fatty tissue and the aponeurosis, which is especially pronounced in obese people in the presence of large cavities between these tissues.

Clinically, seroma is manifested by the discharge of straw-colored serous fluid from the wound.

Treatment of seroma, as a rule, is limited to one- or two-time evacuation of this wound discharge in the first 2-3 days after surgery. Then the formation of seroma stops.

General complications.

Such complications arise as a result of the general impact of surgical trauma on the body and are manifested by dysfunction of organ systems.

Most often after surgery, pain is observed in the area of the postoperative wound. To reduce it, narcotic or non-narcotic analgesics with analeptics are prescribed for 2 - 3 days after surgery or a mixture of antispasmodics with analgesics and desensitizing agents.

Complications from the nervous system. Insomnia is often observed after surgery, and mental disorders are much less common. For insomnia, sleeping pills are prescribed. Mental disorders occur in weakened patients and alcoholics after traumatic operations. If psychosis develops, an individual post should be established and the doctor on duty or a psychiatrist should be called. To calm patients, thorough anesthesia is performed and antipsychotics (haloperidol, droperidol) are used.

Respiratory complications. Bronchitis, postoperative pneumonia, and atelectasis occur as a result of impaired ventilation of the lungs, hypothermia, and most often develop in smokers. Before surgery and in the postoperative period, patients are strictly prohibited from smoking. To prevent pneumonia and atelectasis, patients are given breathing exercises, vibration massage, chest massage, cupping and mustard plasters, oxygen therapy, and a semi-sitting position in bed. Hypothermia must be avoided. To treat pneumonia, antibiotics, cardiac drugs, analeptics and oxygen therapy are prescribed. If severe respiratory failure develops, a tracheostomy is applied or the patient is intubated with breathing apparatus connected.

Most dangerous acute cardiovascular failure- left ventricular or right ventricular. With left ventricular failure, pulmonary edema develops, characterized by the appearance of severe shortness of breath, fine wheezing in the lungs, increased heart rate, a drop in arterial pressure and an increase in venous pressure. To prevent these complications, it is necessary to carefully prepare patients for surgery, measure blood pressure, pulse, and administer oxygen therapy.

As prescribed by the doctor, cardiac medications (corglycon, strophanthin), antipsychotics are administered to adequately replenish blood loss.

Acute thrombosis and embolism develop in severely ill patients with increased blood clotting, the presence cardiovascular diseases, varicose veins. To prevent these complications, feet are bandaged. elastic bandages, give an elevated position to the limb. After the operation, the patient should begin to walk early. As prescribed by the doctor, antiplatelet agents (reopolyglucin, trental) are used; if blood clotting increases, heparin is prescribed under the control of clotting time or low molecular weight heparins (fraxiparin, clexane, fragmin), and coagulogram parameters are examined.

Complications from the digestive system. Due to insufficient oral care, stomatitis (inflammation of the oral mucosa) and acute parotitis (inflammation of salivary glands), therefore, to prevent these complications, careful oral hygiene is necessary (rinsing with antiseptic solutions and treating the oral cavity with potassium permanganate, using chewing gum or a slice of lemon to stimulate salivation).

A dangerous complication is paresis of the stomach and intestines, which can manifest itself as nausea, vomiting, flatulence, and non-excretion of gases and feces. For the purpose of prevention, a nasogastric tube is inserted into the patient's stomach, the stomach is washed and the gastric contents are evacuated, and Cerucal or Raglan is administered parenterally from the first days after surgery. A gas outlet tube is inserted into the rectum, and in the absence of contraindications, a hypertensive enema is used. To treat paresis, as prescribed by a doctor, proserin is administered intravenously to stimulate the intestines. hypertonic solutions sodium and potassium chlorides, use an enema according to Ognev (10% sodium chloride solution, glycerin, hydrogen peroxide 20.0 ml), perform perinephric or epidural blockade, hyperbaric therapy.

Complications from the genitourinary system. The most common symptoms are urinary retention and bladder overflow. At the same time, patients complain about severe pain above the womb. In these cases, it is necessary to induce urination with the sound of a falling stream of water and apply heat to the pubic area. If there is no effect, catheterization of the bladder is performed with a soft catheter.

To prevent urinary retention, the patient should be taught to urinate in a duck while lying in bed before surgery.

Skin complications. Bedsores more often develop in exhausted and weakened patients, with a long-term forced position of the patient on his back, or trophic disorders due to damage to the spinal cord. Prevention requires careful skin care, an active position in bed or turning the patient over, timely change of underwear and bed linen. Sheets should be free of wrinkles and crumbs.

Cotton-gauze rings, a backing circle, and an anti-decubitus mattress are effective. When bedsores occur, chemical antiseptics (potassium permanganate), proteolytic enzymes, wound healing agents, and excision of necrotic tissue are used.

Timing for suture removal.

The timing of suture removal is determined by many factors: the anatomical region, its trophism, the regenerative characteristics of the body, the nature of the surgical intervention, the patient’s condition, his age, the characteristics of the disease, the presence of local complications of the surgical wound.

When the surgical wound heals primary intention The formation of a postoperative scar occurs on the 6th - 16th day, which allows the sutures to be removed within these periods.

So, sutures are removed after operations:

On the head - on the 6th day;

Associated with a small opening of the abdominal wall (appendectomy, hernia repair) - on the 6th - 7th day;

Those requiring a wide opening of the abdominal wall (laparotomy or transection) - on days 9-12;

On chest(thoracotomy) - on the 10-14th day;

After amputation - on the 10-14th day;

In elderly, weakened and cancer patients due to reduced regeneration - on the 14th-16th day.

Sutures placed on the skin and mucous membranes can be removed by a nurse in the presence of a doctor.

Retroperitoneal abscess ICD 10

The sutures are removed using scissors and tweezers. Using tweezers, grab one of the ends of the knot and pull it in the opposite direction along the suture line until a white piece of ligature appears from the depths of the tissue. In the area of the white segment, the thread is crossed with scissors. The removed threads are thrown into a tray or basin. The area of the postoperative scar is treated with a 1% iodonate solution and covered with a sterile bandage.

Abdominal trauma is a closed or open injury to the abdominal area, either with or without violating the integrity of the internal organs. Any abdominal injury should be considered a serious injury that requires immediate examination and treatment in a hospital setting, since in such cases there is a high risk of bleeding and/or peritonitis, which pose an immediate danger to the patient’s life. .

Classification of abdominal injuries In domestic traumatology, the following classification of abdominal injuries is used.

Closed abdominal injuries:
Without damage to internal organs - bruises of the abdominal wall.
With damage to internal organs outside the abdominal cavity. In this case, the bladder, kidneys and some parts of the large intestine are more often damaged.
With damage to the abdominal organs.
With intra-abdominal bleeding. Occurs due to injury to the intestinal mesentery, omental vessels, spleen and liver.
With the threat of rapid development of peritonitis. This includes abdominal injuries with rupture of hollow organs - the stomach and intestines.
With combined injuries of parenchymal and hollow organs. Open injuries belly.
Non-penetrating.
Penetrating without damaging internal organs.
Penetrating with damage to internal organs.
In addition, abdominal injuries can be isolated (one injury), multiple (several injuries, for example, multiple wounds in the abdominal area) and combined (combined with damage to other organs and systems).

Open abdominal injuries.

Open damage can be caused by a firearm, bladed weapon, or secondary projectile.
Incised wounds applied with a knife. Incised wounds have the shape of a line and are quite long in length. The edges are smooth. Often such abdominal injuries are accompanied by significant external bleeding due to intersection large quantity vessels. With extensive damage, eventration is possible - a condition in which an abdominal organ falls into the wound.
Puncture wounds can be applied with a thin knife, bayonet, narrow stiletto, scissors, awl or table fork. Puncture wounds have a thin wound channel and usually bleed slightly. In this case it is possible great depth wound channel and serious damage to internal organs. They pose a serious threat because the patient, seeing a small wound, may underestimate the danger and seek help too late.
Chopped wounds occur when struck with an axe. They are large with fairly jagged edges, with profuse bleeding and extensive soft tissue damage.
Lacerations are formed when attacked by animals or damaged by machinery due to work injury(for example, in contact with a fan blade). These are the most severe, extensive and traumatic wounds. In such cases, tissues and organs have multiple injuries with crushing and ruptures. In addition, as a rule, lacerations accompanied by severe tissue contamination.
Gunshot wounds also belong to the group of particularly severe injuries, since they are accompanied not only by the formation of a wound channel, but also by tissue contusion at a distance of approximately 30 times the diameter of the bullet or pellet. Due to contusion, tissues and organs are stretched, compressed, separated or torn. In addition, abdominal trauma during gunshot wound may be implicit, since the entrance holes in 50% of cases are not located on the anterior abdominal wall, but in other places (for example, on the side or in the lumbar region).
If damaged by a secondary projectile (metal part, glass fragment), lacerations and bruises occur. This type of abdominal injury is common in work accidents and car accidents.

Closed (blunt) abdominal injuries.

A bruise of the abdominal wall is accompanied by pain and local swelling of the injury area. Hemorrhages and abrasions are possible. The pain intensifies with defecation, sneezing, coughing and changing body position.
Rupture of the muscles and fascia of the abdominal wall is manifested by the same symptoms, however, the pain in this case is more severe, so dynamic intestinal obstruction may develop due to reflex intestinal paresis. Additional examination is necessary to exclude ruptures of parenchymal and hollow organs.
Rupture of the small intestine usually occurs from a direct blow to the abdominal area. Accompanied by intensifying and spreading abdominal pain, tension in the muscles of the abdominal wall, increased heart rate and vomiting. The development of traumatic shock is possible.
Rupture of the large intestine is similar in symptoms to ruptures of the small intestine, however, tension in the abdominal wall and signs of intra-abdominal bleeding are often detected. Shock develops more often than with ruptures of the small intestine.
Liver damage occurs quite often with abdominal trauma. Both subcapsular cracks or ruptures and complete separation of individual parts of the liver are possible. In the vast majority of cases, such liver injury is accompanied by heavy internal bleeding. The patient's condition is serious, loss of consciousness is possible. With preserved consciousness, the patient complains of pain in the right hypochondrium, which can radiate to the right supraclavicular region. The skin is pale, pulse and breathing are rapid, blood pressure is reduced. Signs of traumatic shock.
Damage to the spleen. The most common injury in blunt abdominal trauma accounts for 30% of the total number of injuries involving violation of the integrity of the abdominal organs. It can be primary (symptoms appear immediately after the injury) or secondary (symptoms appear days or even weeks later). Secondary splenic ruptures are usually observed in children.
With small ruptures, bleeding stops due to the formation of a blood clot. In case of major damage there is a profuse internal bleeding with accumulation of blood in the abdominal cavity (hemoperitoneum). The condition is serious, shock, drop in pressure, increased heart rate and breathing. The patient experiences pain in the left hypochondrium, possibly radiating to the left shoulder. The pain is relieved by lying on the left side with the legs bent and pulled towards the stomach.
Damage to the pancreas. They usually occur with severe abdominal injuries and are often combined with damage to other organs (intestines, liver, kidneys and spleen). Possible concussion of the pancreas, its bruise or rupture. The patient complains about sharp pains in the epigastric region. The condition is serious, the stomach is swollen, the muscles of the anterior abdominal wall are tense, the pulse is increased, blood pressure is reduced.
Kidney damage due to blunt abdominal trauma is quite rare. This is due to the location of the organ, which lies in the retroperitoneal space and is surrounded on all sides by other organs and tissues. When a bruise or concussion occurs, pain in the lumbar region, gross hematuria (excretion of bloody urine) and fever appear. More severe kidney injuries (crushed or ruptured) usually occur with severe abdominal trauma and are combined with damage to other organs. Characterized by a state of shock, pain, muscle tension in the lumbar region and hypochondrium on the side of the damaged kidney, a drop in blood pressure, and tachycardia.
Bladder rupture can be extraperitoneal or intraperitoneal. The cause is blunt trauma to the abdomen with a full bladder. An extraperitoneal rupture is characterized by a false urge to urinate, pain and swelling of the perineum. It is possible to pass a small amount of bloody urine.
Intraperitoneal rupture of the bladder is accompanied by pain in the lower abdomen and frequent false urges for urination. Due to urine spilled into the abdominal cavity, peritonitis develops. The abdomen is soft, moderately painful on palpation, bloating and weakening of intestinal peristalsis are noted.

Infected abdominal wound ICD 10. Blunt abdominal trauma, open abdominal injuries

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The seam becomes wet after surgery

Alphabetical index of diseases according to ICD-10. Part 3

Removal of inguinal hernia - all the features of the procedure - Complications

Early complications of postoperative wounds

Read also:

Memo for the patient after surgery

International Classification of Diseases

Causes and treatment of wound suppuration after surgery

Postoperative complications

Retroperitoneal abscess ICD 10

Classification of abdominal injuries In domestic traumatology, the following classification of abdominal injuries is used.

Open abdominal injuries.

Closed (blunt) abdominal injuries.