Lesions of the Stomach.—Blows seldom cause rupture of the stomach, the elas ticity of the organ, even when contain ing liquid or semiliquid material, being such as to cause it to escape injury under sudden impact or great pressure. It is also protected by the lower ribs, the liver, and the intestines. Nevertheless, this organ is occasionally involved in traumatism affecting other abdominal viscera. In the majority of cases the rent is found near the pyloric orifice, but the greater curvature may be the seat of the lesion, while the entire organ is occasionally torn from end to end. In the latter case, however, death ensues almost immediately in practically all cases. Pressure during lavagc of the stomach may also cause laceration of the mucous membrane.
Case of a man who died in coma after several washings of the stomach for opium poisoning. At the necropsy sev eral rents of the mucosa were found. Conclusion that the presence of the fluid was the cause of the injury, by pressure. Key-Aberg (Deutsche mcd. Zeit.. Apr. 2S, '92).
In the case of incomplete tears there may be lnematemesis and severe localized pain resembling that of gastric gnawing and burning in character. This is followed by localized inflammation with tendency to the formation of sions. Ihemorrhage between the coats of the stomach may also occur in incom plete tears, a cyst-like pocket being formed.
Violent pressure upon the stomach may cause it to be crushed against the spinal column, and the mucous surfaces be lacerated by interpressure of the an terior and posterior walls of the organ. In such a case a marked lesion neces sarily follows, giving rise to copious hcematemesis.
Case of a boy who was caught between two freight-ears. Shock and vomiting of blood, but no external injury. Twelve hours after the accident the abdomen opened and a slight laceration in the spleen sutured. No other injury found. The autopsy showed two ruptures of the mucous membrane of the stomach,—one of the anterior wall about its middle and the other opposite to it in the posterior wall, the mucous membrane alone being stripped from the muscular layers. J. H. Clayton (Brit. Med. Jour., Mar. 24, '94).
The presence of rupture of the stom ach can be ascertained by inflating the organ with hydrogen-gas through an elastic stomach-tube. If the organ be dilated by this procedure, penetration beyond the mucous coat is improbable. If the stomach cannot be distended, complete rupture has taken place, and tympanites, due to the presence of the gas in the cavity proper, will be recog nized.
Rupture of the stomach implicates the peritoneal coat in the majority of cases, the elasticity of the peritoneal invest ment being less than that of the two internal coats: muscular and mucous. The contents of the stomach, or a por tion of them, escape into the peritoneal cavity and cause severe suffering and shock, followed promptly by death or septic peritonitis.
Lesions of the Liver.—The liver, owing to its friable nature, its size, and its anatomical position, is the organ most frequently injured, because indirect con cussion may cause a profound lesion. A fall from a great height into water may thus cause a gaping rent of the capsule and parenchyma and open a large num ber of vessels. Severe and sudden blows of any kind, especially those involving much surface, over the abdominal wall may thus cause injury to this organ. Again, its softness, which may be in creased by hypertrophy, causes it to yield readily to the crushing produced by carriage-wheels, car-bumpers, etc.
The severity of all the general symp toms is usually increased. The pain, when the liver is seriously injured, is peculiar; it radiates from the right hypochondrium to the waist, the scro biculus cordis, or the scapular region. . The respiration is generally embar rassed; there is marked shock. Examina tion of the faces may show the absence of bile, especially if the bile-duct is rupt ured: an occasional complication. The dissemination of bile in the system causes itching and, after a time, jaundice. The escape of bile into the peritoneal cavity may not give rise to peritonitis, however, this fluid being aseptic. A serous exudate may result from the irri tation caused by its presence, forming a composite fluid which may be retained in the peritoneal cavity a considerable time.
Case in which, after severe contusion in the hepatic region, swelling, with considerable rise of temperature, super vened. Incision in the median line. A cavity, from which about a quart of reddish fluid issued, found. Recovery. Lyonnet and Jabonlay (Lyon Med., No. 10, '95).
Case of rupture of the liver in which there was copious exudation into the abdominal cavity. Urine containing bile; stools ash-gray. Seven quarts of dark mahogany-colored fluid withdrawn, and found to contain much binary pig ment, especially biliverdin. Recovery. Roux (Le Bull. Med., Dee. 8, '95).