Blunt abdominal trauma. Symptoms Diagnostics. Urgent Care

The human body is often exposed to a wide variety of injuries: bone fractures, joint dislocations, sprains and tears of ligaments and muscles, etc. An abdominal strain is a traumatic injury to the muscle fibers of the anterior, posterior, and lateral muscles, which are anatomically located between the lower ribcage and the upper rim of the pelvis.

Almost anyone can get such an injury as a result of muscle strain caused by various loads exceeding the permissible norms. For each person, this norm is individual and depends on his physical condition, muscle tone and muscle development.

Most often the problem is observed in a sports environment. Despite the satisfactory physical development of people involved in professional sports, strained abdominal muscles are quite common during training or during competitions.

In everyday life, a sprain can occur as a result of lifting significant weights or performing physically difficult work. Often, muscle strain is observed in women after pregnancy and childbirth.

Muscle strain occurs as a result of significant and sharp muscle contraction, which is accompanied by pain of varying degrees of intensity. In most cases, this pathology begins with minimal sprains, which practically do not give any symptoms and can only cause minor discomfort to the patient.

In the future, the damaged parts of the muscle mass are separated more and more from each other and ultimately this can lead to muscle tissue rupture.

Often this situation occurs when a person, without proper physical preparation and warm-up, tries to perform complex stretching and flexibility exercises with a significant amplitude of deviation from the normal body position. Also, muscle spasm is possible with a sudden change in body position, when lifting significant weights and, less often, during falls and collisions.

It is important to note that if there is excessive pressure on the abdominal area, there is a risk of rupture of the abdominal wall. In this case, there may be a displacement of internal organs, called a hernia in medicine.

The most common way to get a sprain is to lift heavy objects. The risk is especially high in people with poorly developed muscles and a low level of physical activity in everyday life.

Classification of abdominal muscle strains by severity

Classification of abdominal muscle strain occurs depending on the severity of the injury. In medical practice, it is customary to diagnose all cases with sprains into three main stages:

1. The first, moderate degree of sprain, in which no special treatment is required, and all symptoms and pain disappear after 1-2 weeks, provided that the patient adheres to a gentle regimen.
2. The second, moderate degree, in which the symptoms are expressed with a moderate degree of intensity, but disappear after a couple of weeks. At this degree, in some cases patients require qualified treatment. Recovery usually occurs 3-6 weeks after the incident.
3. The third, severe degree, in which there is often a rupture of the abdominal muscle group. The symptoms are pronounced. Most often, the connecting bridge of the abdominal press ruptures. The damaged muscle is unable to contract. Treatment, sometimes even surgical, lasts in this case an average of 3 months.

Signs of damage

Often, symptoms associated with these types of injuries can indicate other health problems. Only the attending physician can make a final diagnosis. The following are symptoms of abdominal muscle tension:

• painful sensations in the abdominal wall;
• discomfort in the abdominal tissues, which may shrink;
• pain when touching, straining, or bending muscle tissue;
• muscle cramps;
• bruises;
• swelling on the right or left side of the abdominal wall, depending on which abdominal muscle is injured.

Abdominal pain caused by tight abdominal muscles

Characteristic symptoms of sprain

When the abdominal muscles are stretched, standard symptoms characteristic of this pathology are observed. If sprains are accompanied by microtears of the muscles, then the symptoms may appear more clearly and be more intense. The main clinical manifestations of this pathology are the following:

• feeling of discomfort in the area of ​​damaged muscles;
• pain when trying to flex the torso and tensing the abdominal muscles;
• sharp, increasing pain upon palpation at the site of sprain;
• spasms of the abdominal muscles;
• in especially severe cases, the formation of edema and hematoma is possible, which should be a signal for the victim to urgently seek qualified help.

How to determine abdominal diastasis yourself

To check your stomach yourself and recognize diastasis, you need to lie on a flat surface and bend your knees. Place one hand behind your head. Then as you exhale

lift your upper body as if doing abs. This makes it easier to detect the boundaries of the rectus abdominis muscles. With your other hand, feel the middle of your stomach, between the abdominal muscles. Diastasis is felt especially well in the navel area, since anatomically the white line of the abdomen is wider in this place.

And don’t be alarmed when you find a discrepancy - if the distance between the muscles does not exceed 3 centimeters, everything is fine. More means you need to schedule an appointment with your surgeon. You decide for yourself whether to have surgery or not, but it is necessary to make a diagnosis.

On the left is diastasis of the white line of the abdomen, on the right is a normal, healthy abdomen.

Diagnostic methods for abdominal muscle strain

In addition to medical problems associated with stretching the abdominal muscles, many patients also have to deal with aesthetic problems.

To avoid many problems with the functioning of internal organs, including the digestive system, the formation of hernias, prolapse of internal organs, further muscle damage and their divergence along the central line of the peritoneum after childbirth, it is necessary to diagnose a sprain in a timely manner. This will allow you to prescribe the correct treatment regimen in a timely manner and will contribute to the complete restoration of the muscular system.

Also, if any symptoms of muscle strain in this area of ​​the body appear, timely treatment is very important for women who are preparing for pregnancy or are in the early stages of pregnancy. This will help avoid a number of problems that may worsen later and after childbirth.

Publications in the media

Abdominal injuries can be open or closed. Open injuries are often gunshot or stab wounds, less often cut wounds. Closed injuries occur in transport accidents, falls from a height, or strong blows to the abdominal wall.

Clinical picture • Open injuries: the presence of a wound opening •• The omentum may fall out of the wound, intestinal contents, urine may flow •• The clinical picture depends on the organ damaged by the injury - with damage to the liver and spleen, intestinal mesentery, bleeding occurs with signs of acute blood loss •• With damage to hollow organs, signs of peritonitis usually develop • With closed injuries, there is no defect in the skin of the abdominal wall •• In case of damage to hollow organs with the entry of their contents into the free abdominal cavity, severe pain occurs, tension in the muscles of the abdominal wall and positive symptoms of irritation of the peritoneum (presence of intra-abdominal bleeding can neutralize the pain syndrome) •• Splenic ruptures with intra-abdominal bleeding often occur (weakness, pale skin, cold sweat, tachycardia, decreased blood pressure, tension in the muscles of the abdominal wall, dullness of percussion sound in sloping areas of the abdomen, the “vanka-vstanka” symptom - increased pain when the patient is in a horizontal position) - 35%, kidneys and urinary tract - 24%, liver - 18%, stomach - 10%, retroperitoneal organs - 10%, etc. • Alcohol intoxication makes it difficult to adequately (both objective and subjective) assessment of the patient's condition.

Diagnosis • Physical examination: the absence of hepatic dullness on percussion indicates a rupture of a hollow organ, dullness of percussion sound in sloping areas of the abdominal cavity - internal bleeding • Plain radiography of the abdominal organs - a strip of gas under the diaphragm may indicate damage to a hollow organ • Examination of the contents of the abdominal cavity using a “groping catheter” is indicated when it is impossible to exclude damage to internal organs •• Preliminary emptying of the bladder (with a catheter) and stomach (by introducing a nasogastric tube) •• The catheter is inserted through an incision made in the midline of the abdomen below the navel (if there is a postoperative scar - at another point). By introducing a physiological solution into various parts of the abdominal cavity through it, it is possible to detect the presence of blood, bile, and intestinal contents in it • Ultrasound helps to identify damage to parenchymal organs, the presence of fluid in the abdominal cavity • CT is the most informative method for diagnosing damage, incl. h. and retroperitoneal organs (kidneys, pancreas, aorta), differential diagnosis of retroperitoneal hematomas and damage to parenchymal organs (in the presence of a small amount of blood in the abdominal cavity) • Emergency laparoscopy is very informative, clarifying the location and nature of the damage • If doubts remain regarding damage to the abdominal organs cavity, diagnostic laparotomy is justified • Some additional and special diagnostic methods •• Excretory urography helps to identify unilateral retention or absence of urine output, leakage (depot) of contrast •• Retrograde ureterography allows you to detect ureteral rupture •• Cystourethrography is a valuable diagnostic method for pelvic fractures and the presence bleeding from the urethra.

Surgery _

• The optimal access is a midline laparotomy.

• The most important points in the surgical treatment of abdominal injuries are a thorough examination of the abdominal orgas to identify all possible injuries. The first task of the doctor is timely diagnosis and stopping of intra-abdominal bleeding. In emergency cases, against the background of massive infusion therapy, surgical intervention is immediately performed •• Bleeding from the aorta and its main branches during surgery is temporarily stopped by applying a vascular clamp, while simultaneously performing resuscitation measures and blood reinfusion •• Parenchymal bleeding is stopped by tight tamponade with napkins •• Non-viable areas the intestine is resected using a hardware suture •• The main stage of the operation is performed after the patient’s condition has been stabilized •• In patients in critical condition, the main stage can be delayed (“Damage Control” tactics). In this case, temporary closure of the abdominal wall is performed and intensive therapy is continued until shock is recovered. Surgical treatment is carried out after 12–24 hours.

• In case of liver damage, first of all, it is necessary to perform thorough hemostasis •• Shallow but bleeding liver fissures are sutured with mattress or cross-shaped sutures •• If there is crushing or significant ruptures with almost complete separation of part of the liver, this part is removed. If necessary, hepatoomentopexy is performed.

• Intestinal damage. Incised wounds (in the early stages) are sutured. For ruptures due to blunt trauma, gunshot wounds, multiple incised wounds over a limited area, resection of the corresponding section of the intestine is indicated. In the case of multiple wounds, anastomoses, clinical picture of peritonitis, retroperitoneal hematoma, nasointestinal intubation of the intestine is indicated for decompression in the postoperative period.

• Kidney damage. Bruises and interstitial hematomas are treated conservatively. Open wounds are sutured with a discharge pyelostomy. If part of the kidney is crushed, resection of the corresponding pole is performed; in the case of complete crushing of the kidney (and the presence of a functioning second), nephrectomy is performed. Damage to the vessels of the renal pedicle is not an indication for nephrectomy (a vascular suture is indicated).

• Retroperitoneal hematomas •• Surgical intervention is indicated when retroperitoneal hematomas progressively increase in volume and the source of bleeding is identified angiographically, since in most cases their occurrence is associated with fractures of the pelvic bones, and they, as a rule, cannot be revised. If possible, angiographic embolization of the bleeding vessel is performed • • Retroperitoneal hematomas of the upper abdomen (especially in the area of ​​the duodenum, pancreas and renal pedicles) should be given special attention ••• Before performing an inspection, it is advisable to place tourniquets under large vessels ••• Laparoscopic examination hematomas helps to establish their nature, the presence of additional impurities (for example, bile, air) ••• In case of retroperitoneal rupture of the duodenal wall, only its early detection and suturing contribute to the success of further treatment, subject to additional surgical measures for decompression of the duodenum and high-quality drainage of retroperitoneal tissue . To clarify the diagnosis in such cases, emergency FEGDS is indicated. ••• For transverse ruptures of the pancreas, the method of choice is its distal resection.

ICD-10 • S30 Superficial trauma of the abdomen, lower back and pelvis • S31 Open wound of the abdomen, lower back and pelvis • S36 Trauma to the abdominal organs • S37 Trauma to the pelvic organs • S39 Other and unspecified injuries of the abdomen, low back and pelvis • • S39.0 Injury to muscles and tendons of the abdomen, lower back and pelvis

Treatment of abdominal distension

Treatment of the disease directly depends on the intensity and severity of the symptoms and the extent of the injury. So, with different degrees of severity, it can last from several days to several months.

The main thing for patients with this injury is to ensure complete rest for the abdominal muscles and the absence of any, even the most minimal, loads. In everyday life, you should avoid lifting heavy objects, sudden movements and other actions that cause contraction of the abdominal muscles. A gentle regimen is especially important in the first two days after the incident.

For moderate and severe sprains, it is recommended to apply cold in sessions of 15-20 minutes with breaks. Cold compresses will help reduce pain. As cold, you can use compresses made from ice cubes wrapped in cellophane and a towel. Applying ice directly to exposed skin is not recommended.

To relieve severe and intense pain, the doctor may prescribe anti-inflammatory drugs and analgesics in the form of tablets, injections or ointments. This will help significantly alleviate the condition and general well-being of the patient.

When the pain goes away, you can begin to gradually stretch the affected muscle. To do this, you can perform the most gentle exercises, gradually complicating them and increasing the load.

In some cases, patients with these problems have to turn to modern plastic surgery. In this case, problems of an aesthetic nature are eliminated to a greater extent.

Prevention

The need to comply with preventive measures concerns everyone. Experts recommend:

• Always warm up before starting the main part of your training program;
• do not overexert yourself in sports and in everyday life;
• do not make sudden movements when lifting weights;
• stop activity immediately if tired;
• Strengthen your abdominal muscles with special exercises.

Abdominal strains and tears are a serious injury, but their prevention is very simple. It consists in the formation of physical endurance of the body and its individual parts. The unpleasant symptoms of abdominal muscle strain and treatment, which takes many weeks and months, are a strong argument in favor of playing sports from a very early age. Athletic and physically developed people can withstand everyday stress more easily, they are stronger and more resilient. In addition, to gain physical shape, you just need to do basic exercises at home.

What to remember after an injury

Warm-up warm-ups before actual training will be very effective in reducing the likelihood of getting this injury in a sports environment. To do this, it is recommended to perform standard stretching exercises, warm-up jogging, etc. for 20 minutes.

In order to avoid sprains in everyday life, you need to calculate your strength when you have to do physical work with lifting weights. When performing it, it is recommended to take breaks and rest.

To maintain your muscles in tone and strengthen them, it is very important to give your muscles optimal loads on a systematic basis. You can, for example, visit gyms several times a week, do morning exercises, or go for daily jogging.

Causes

First of all, beginner athletes are at risk for straining the abdominal muscles. They really want to train, but they don’t know about safety precautions. The easiest way to get injured is to start doing heavy abdominal exercises without warming up. Unheated muscle structures do not have sufficient elasticity and endurance; they are easily torn.

In addition to the lack of warm-up, there are a number of negative factors that inexperienced athletes do not pay due attention to. If the chosen training program is too difficult, then even a good warm-up will not protect against injury.

Therefore, loads should increase gradually and only at the moment when the body is exactly ready for it.

You cannot train in the cold; at low ambient temperatures it is difficult to maintain the muscular system in a sufficiently warmed state. In the same way, you cannot train through fatigue. If you feel tired, it means your body needs rest.

The main reasons include:

• too intense physical impact;
• performing crunches at too high an amplitude;
• lack of warm-up before training;
• lifting weights;
• performing exercises using the wrong technique;
• muscle weakness;
• pregnancy.

Girls during pregnancy and after the birth of a child take no less risk than amateur athletes. The physical load on the mother's body increases as the fetus grows; if she does not keep herself in good shape, then the muscles may not be able to withstand it. After the baby is born, you have to lift him in your arms, and this is also a high load.

After operation

Rehabilitation after suturing of diastasis depends on the volume of intervention and requires from 1 to 4 weeks. You will need to wear surgical underwear for a month.

Endoscopic surgery involves discharge the next day.

After abdominal surgery, you need to spend a day in the hospital. You can get up and walk on the day of surgery. The stitches are removed on the 8th day. After 14 days, physical activity is allowed. After a month, you can return to your normal lifestyle.

Suturing of diastasis recti in 99% of people lasts a lifetime. The operation is not a contraindication to planning a pregnancy.