In diagnosis of rupture of the spleen vomiting is a most important guide; in simple contusion of the alimentary tract it seldom, if ever, occurs.
After injury, the patient may be able to walk or drive for half an hour or even more. Then there is a feeling of acute pain in the splenic region, and a sense of extreme weakness. On examining the body the splenic region is tender, dull on percussion, and rigid. There is pain on deep inspiration, the breathing is short and jerky, and a fracture of the ribs may be suspected. Pain spreads over the ab domen; abdominal distension and rigid ity become apparent, especially in the upper left quadrant of the abdomen. Symptoms of hemorrhage now develop rapidly, pallor, extreme anxiety, thirst, small frequent pulse, and vesical tenes mus. Trendelenburg (Dent. med. Woch., Oct. 5, '99).
Enlargement and disease of the spleen greatly predispose to rupture. Hremor rhage is the most constant symptom, though this may be caused by rupture of the mesentery or liver. More charac teristic and less constant is pain in the region of the spleen and of more impor tance is dullness of the percussion-note extending over the left upper abdominal and left lumbar regions. When let alone a rupture of the spleen is almost always fatal from hemorrhage. Lewerenz (Ar chiv f. klin. Chir., B. 60, H. 4, 1900).
Lesions of the Kidneys.—The kidney is firmly held in place by its attachments, while its consistence is such as to pre clude elasticity. Hence, a blow or undue pressure may cause rupture. All the causes of injury that may take part in the production of lesions elsewhere may also induce renal lesions, which may con sist of contusion, rupture, or laceration.
Thirty-six cases of renal lesions of traumatic origin. An abundant hmmor rhage may take place without any rupt ure from tearing of the vascular net work surrounding the organ, and which sometimes becomes engorged. GUter bock (La Semaine MM., July 3, '95).
Haematuria is valuable only as show ing the fact of rupture of the kidney, but not as a symptom by which to de cide on operating. It is not the visible loss of blood by the bladder, but the easily overlooked, but far more danger ous, bleeding into the perinephric tissues, or into the peritoneal cavity, that should receive the chief attention. W. W. Keen
(Annals of Surg., Aug., '96).
Injury of the kidney and parenchyma- I tous nephritis. Case of a boy, aged 7, who was run over by a coal-cart, the wheels of which passed over the right leg and the right lumbar region. On ca theterization immediately after the acci dent, 2 ounces of normal urine with drawn. No pain. Two hours later he passed 12 ounces of bloody urine. Ex amination made thereafter showed hrema turia. The blood from the body gave indications of lencocytosis. The condi tion of the kidney gradually improved with rest in bed, and six weeks after the injury the patient discharged as recov ered. J. Yarrow (N. Y. Med. Jour., Jan. 6, 1900).
Besides the symptoms common to severe abdominal traumatism there may be increased pain in the lumbar region with radiations in the direction of the pubis and rigidity of the muscles. Dull ness on percussion is sometimes elicited. Anuria may also occur, but this is not a characteristic sign. Hwmaturia is an important indication of renal laceration, however, although it may not present itself at once; it may be followed by the appearance of pus. The catheter should be used in these. Retraction of the testicles is also said to occur (Bayer). The ureter is very rarely involved; when it is, the symptoms are not modified. Enlargement of the lumbar and hypo chondriac regions is present in the ma jority of severe cases, but may supervene late iu the history of the case.
Thanks to the compensatory work of the uninjured kidney, the mortality of renal lesions is not so marked as when other abdominal organs are injured.
Statistics of 120 cases, showing 53 re coveries and 67 deaths: a mortality of 53.7 per cent. Reckzy (Wiener klin.
Woch., Nov. S, 'SS).
Even severe wounds have been known to heal. If large renal vessels are torn, marked lividity occurs, the patient rapidly becoming exsanguine. Death may thus follow very soon. Involve ment of the peritoneum in the injury is promptly followed by peritonitis, the signs of this affection appearing a few hours after the receipt of the injury. Sepsis is not an infrequent complication in nnoperated cases.