ABDOMEN, INJURIES OF THE. Contusion.
Symptoms. — The symptoms attend ing a contusion of the abdomen, whether caused by blows, kicks, spent bullets, the passage of heavy bodies—such as ve hicles—over the abdomen, etc., are not always such as to call attention to the seriousness of the lesion present. The gravest abdominal injuries may co-exist with practically no external or general indication of mischief, the patient walk ing a long distance, perhaps, without ex periencing anything more than slight local pain where the blow had been re ceived.
Case of traumatic rupture of the small intestine caused by a very slight blow which left no mark. Extensive peri tonitis and free exudate were present six hours after the injury, although their was almost entire absence of symptoms apart from cessation of peristalsis and slight vomiting. J. J. Buchanan (An nals of Surg., Nov., 1900).
From observations of sonic twenty eases of visceral injury, following con of the abdomen, verified by opera tion or autopsy. the most prominent were pain, tenderness, and museular rigidity, and likewise the most reliable. The deep-seated, localized pain following injury, especially increased by pressure, and accompanying local or general mus cular rigidity. is one of the most con stant signs of intra-abdoininal injury.
The association of these three symptoms is almost pathognomonie of abdominal irritation. Pain. however, is often pres ent, with tenderness, in injuries limited to the abdominal wall: but in these in stances muscular rigidity is generally absent. In the absence of subcutaneous pain localized tenderness with rigidity is strongly
of visceral in jury. Of the three symptoms, muscular rigidity is the most reliable, and some times the only sign. In the absence of other
abdominal rarity A re very suggestive ft. E. Brewer (Annals of Surgery. Feb., 1903).
The abdominal walls may be but slightly injured; but, again, the lesions may consist of extensive extravasations of blood between the layers, or sufficient laceration of the muscular and other tis sues to give rise to more or less local sloughing. Such lesions of the abdom inal wall, however, are not always ac companied by injury of the abdominal organs.
A trilling superficial injury of the abdominal wall may be associated with serious internal lesions, owing to the re sistance offered by the abdominal walls and the fragility of the abdominal or ,..i1116. The external appearances, there fore, should not be taken as a criterion.
Narrow bodies, the action of winch is exerted on a small area, reach more deeply by overcoming resistance of the abdominal parities more easily than larger bodies. Resistance varies with the age, state of obesity, and state of relaxation or contraction of the muscles. The direction of the blow is of impor tance. If perpendicular to the deeper structures, it is most harmful; when parallel, it tends to glide off; when oblique, the force is modified. Demons (Brit. :Med. Jour., Nov. 27, '97).
Case of young man riding bicycle when lie was struck in upper part of abdomen by end-pole of an express-cart coming in opposite direction. He was thrown from wheel, but recovered himself soon. Only symptom slight lain and tenderness at scat of injury. Three hours later general abdominal pain and tenderness, steadily increasing. Temperature rose quickly five hours after injury. Abdomen was opened: in first eight inches of small intestine drawn out of wound two rents encountered, the larger was complete and involved half-circumference of gut. Smaller one partial, involving peritoneal covering and part of muscular coat only. Beginning peritonitis present. No ex travasation of intestinal contents. No evidence of haemorrhage of importance. Five inches of intestine, including in it both rents, resected, and bowel sutured. Recovery complete on twenty-fourth day. Francis S. Watson (Boston Med. and Surg. Jour., Feb. 10, '98).