ABDOMINAL INJURIES - Medicine for Mountaineering and Other Wilderness Activities - page 129

Abdominal Pain Due to Ruptured Liver or Spleen
A blow to the upper abdomen or lower chest may result in pain, tenderness, and eviden-
ceofcontusionintheareaofimpact,andoneormoreribsmaybebroken.Shortlyafterthe
injury,intraabdominalpainappears,firstintheregionoftheinjuryandlatermorediffusely
throughout the abdomen. The pain is usually aggravated by breathing deeply and may be
associatedwithpainintheshoulder.Individualswitheitheroftheseinjuriesusuallyappear
to be in reasonably good condition at first, but as hours go by their condition deteriorates.
Signs of shock progress, and the abdomen becomes diffusely tender with rebound tender-
ness, reduced bowel sounds, and distension.
Apersonwithaninjuryofthespleenmayrecoverfromtheinitialaccidentonlytobleed
massively when a clot breaks loose from the splenic surface several days or even weeks
later. Signs of intraabdominal hemorrhage appear rapidly after such events. Persons with
suchinjuriesmustbeevacuatedtothecareofasurgeonasrapidlyaspossible.Hemorrhage
rarely stops spontaneously; most individuals bleed to death if not surgically treated.
Peritonitis Due to Ruptured Intraabdominal Organ
Severe blunt abdominal trauma may rupture one of the hollow intraabdominal organs,
such as the intestines. The contents of the damaged organ are spilled into the abdominal
cavity, producing peritonitis. Following injury the pain gradually becomes worse and
spreads over the entire abdomen as peritonitis becomes generalized. Diffuse tenderness,
abdominal distension, vomiting, and fever soon appear. Treatment is the same as for peri-
tonitisofanycause( Chapter20:AcuteAbdominalPain ).Theurinarybladderisrarelyrup-
tured unless it is full at the time of injury, and usually rupture is associated with a fractured
pelvis. If the bladder is ruptured, no more urine is voided except for a few drops that are
mostly blood. This injury also demands prompt evacuation.
PENETRATING ABDOMINAL INJURIES
Penetrating or perforating injuries of the abdomen are unusual in the wilderness but occa-
sionally are caused by a fall on a sharp object. These injuries are extremely serious and
require operative treatment. Not only are the abdominal organs injured, but the abdominal
cavity is contaminated from external sources, resulting in severe peritonitis. The diagnos-
is is usually obvious, but a penetrating abdominal wound may be overlooked. Attention
must not be limited to the area of most obvious injury. The person should be stripped of all
clothes and the entire abdomen and back carefully checked, including the underarms and
buttocks.
Evacuation should be carried out as quickly and rapidly as possible. During evacuation
theindividualshouldbetreatedforperitonitis,andshockshouldbeanticipatedandtreated.
A sterile dressing should be placed over the wound. In contrast to the usual care given
softtissue injuries, the wound should not be washed or cleaned, because such efforts may