Gunshot wounds to the abdomen

First medical aid. At the MPP, wounded people in the abdomen are bandaged, antibiotics, tetanus toxoid, analgesics are administered, and, if indicated, cardiac medications. In the cold season, the wounded must be warmed: covered with heating pads, wrapped in a blanket or sleeping bag. For penetrating wounds, especially in cases of life-threatening blood loss, it is necessary to administer blood substitutes. Such wounded are subject to evacuation first. Following them, in the second place, the wounded are evacuated, in whom, against the background of relatively satisfactory health and stable general condition, there is a suspicion of a penetrating nature of the abdominal wound. Only those in agony who are receiving symptomatic treatment are detained at the MPP.

Qualified medical care. In the medical hospital (omedo), those wounded in the stomach are divided into the following groups:

With symptoms of internal bleeding - immediately sent to the operating room in the first stage;

With penetrating wounds without signs of bleeding, as well as with clinical severe symptoms peritonitis is sent to the anti-shock ward for intensive care and preparation for surgery in the second stage;

The wounded with suspected penetrating abdominal wounds are sent to the operating room in the second stage, where they undergo progressive widening of the wound or laparocentesis (laparoscopy). Depending on the result, either a laparotomy is performed for a penetrating abdominal wound, or, if necessary, only surgical treatment wounds abdominal wall;

Those in agony are sent to the hospital department for symptomatic therapy.

In the event of a large number of wounded, when it is impossible to provide qualified assistance to all those wounded in the stomach within 3-4 hours, evacuation as soon as possible is permissible medical institution those who do not have signs of internal bleeding.

Preoperative preparation depends on the general condition of the wounded and the nature of the injury. To carry out infusion-transfusion therapy, catheterization of the central veins is necessary. It is based on intravenous infusions crystalloid and colloid solutions with broad-spectrum antibiotics. Duration of preoperative infusion therapy should not exceed 1.5–2 hours. If internal bleeding continues, intensive anti-shock therapy should be carried out simultaneously with the operation.

Laparotomy performed under endotracheal anesthesia with muscle relaxants. An incision into the abdominal wall should provide the opportunity for a detailed examination of all departments abdominal cavity. The most convenient is the median approach, as it allows for a complete inspection of the abdominal organs and retroperitoneal space; if necessary, it can be extended in the proximal or distal directions and supplemented with transverse incisions.

Intestinal loops or strands that fall out through the wound greater omentum washed with an antiseptic solution. The intact intestine is inserted into the abdominal cavity, expanding the abdominal wall wound if necessary. To prevent the leakage of intestinal contents, wounds of the intestinal wall penetrating into the lumen are closed with elastic intestinal sponges, followed by suturing. The changed area of ​​the omentum is subject to resection.

After opening the abdominal cavity, surgery is carried out in the following sequence: 1) identification of the source with temporary or final stop of bleeding; 2) systematic revision of the abdominal organs; 3) intervention on damaged organs; 4) intubation small intestine(according to indications); 5) sanitation, drainage of the abdominal cavity and retroperitoneal space; 6) closing the abdominal wall wound; 7) surgical treatment of entry and exit wounds.

The main principle surgical intervention for abdominal wounds with damage to the abdominal organs and retroperitoneal space is to stop bleeding as soon as possible. Its most common sources are damaged liver, spleen, mesenteric and other large abdominal vessels, kidneys, and pancreas. An important treatment method traumatic shock in these wounded there is reinfusion of blood that has poured into the abdominal cavity. Blood that appears uncontaminated is collected using suction, after which it is filtered (permissible through several layers of gauze) and reinfused. In case of damage to hollow organs, kidneys and ureters, it is advisable to transfuse canned blood or its erythrocyte-containing components. In the absence of blood supplies and severe blood loss, reinfusion of autologous blood under the guise of antibiotics is justified, even in the case of injury to hollow organs. A contraindication to reinfusion is considered to be massive contamination of the contents of hollow organs by blood spilled into the abdominal cavity.

Stopping bleeding from large vessels of the abdomen(abdominal aorta and inferior vena cava, iliac vessels, portal vein, vessels of the kidney, spleen). After temporary compression, the aorta is isolated from the esophagus: the left triangular ligament is dissected and retracted to the right side left lobe liver, apply a vascular clamp or tourniquet to the abdominal aorta. To inspect the aorta and its branches, left iliac vessels, extraperitoneal parts of the left half of the colon, left kidney, adrenal gland and ureter, the parietal peritoneum is dissected along the left lateral canal along the outer edge of the descending and sigmoid colon, and sometimes the spleen. These formations are peeled off in the medial direction along with the mesenteric vessels, and, if necessary, with the tail of the pancreas and mobilization of the splenic flexure of the colon. Access to the inferior vena cava, right iliac vessels, extraperitoneal parts of the right half of the colon, right kidney, adrenal gland and ureter is carried out by dissecting the parietal peritoneum along the right lateral canal. Then the cecum, ascending and mobilized hepatic flexure of the colon are peeled off, and if necessary, mobilization is performed duodenum according to Kocher.

After exposing the vessels and temporarily stopping the bleeding (clamping throughout, tight tamponade, application of tourniquets and vascular clamps), a vascular suture is applied, both lateral and circular anastomosis, and in case of a large defect, autovenous grafting is performed. In the absence of ischemia or the impossibility of restoring the integrity of a large vessel, they resort to the application of rigid clamps with ligation or suturing of the damaged vessel. In a difficult situation (development of a terminal condition), ligation of the inferior vena cava below the confluence of the renal veins, the superior mesenteric artery below the origin of the first small intestinal branch, as well as one of the ducts of the portal vein (superior, inferior mesenteric, splenic veins) is permissible. When ligating two or more mesenteric arteries, in all cases it is necessary to monitor the state of the intramural circulation of the intestine. If necrosis develops, it is resected. Be sure to drain the damaged area.

Gunshot wounds of all abdominal organs are subject to surgical treatment , which is a mandatory and important stage of the operation. During surgical treatment of parenchymal organs, visible necrosis is excised, foreign bodies and blood clots are removed, since failure to do this leads to the development of severe complications (repeated bleeding, formation of purulent foci). Stopping bleeding and suturing wounds of parenchymal organs is done using piercing needles and threads made of absorbable material (Polysorb, Vicryl, catgut).

For gunshot defects of hollow organs (stomach, intestines), economical excision of wall tissue up to 0.5 cm around the wound is performed. When performing surgical treatment, it is taken into account that a sign of the viability of the wall of a hollow organ is clear bleeding from the edges of the wound. Failure to comply with this rule is accompanied by a high rate of failure of sutures and the development of life-threatening complications. All hematomas of the walls of hollow organs are subject to mandatory revision to exclude damage penetrating into the lumen. Suturing and forming anastomoses on hollow organs are performed in 2 rows. The first row of sutures is applied through all layers using absorbable threads (polysorb, vicryl, polydiaxonone, catgut), the second - seromuscular - from non-absorbable material (prolene, polypropylene, nylon, lavsan).

At liver injury the scope of surgical interventions depends on the degree of damage; the general principles are reliable bleeding control and complete surgical debridement of the liver wound. For peripheral ruptures, suturing with U- or Z-shaped sutures made of absorbable material, packing of the liver wound, and omentohepatopexy are used. With deep ones, especially central damage organ, preference is given to atypical or anatomical resections with mandatory drainage biliary tract regardless of the presence or absence of bile leakage from a liver wound. In case of crushed lobes, as well as multiple ruptures of both lobes, liver resection or lobectomy is indicated. In critical situations, for the purpose of hemostasis, tight tamponade or compression of the liver with a bandage and tampons is used by fixing them to the ligamentous apparatus. The wounded area should be drained with a tube placed in the right hypochondrium.

Bleeding from a wound spleen usually requires removal of the organ. It is imperative to drain the left subdiaphragmatic space with drainage in the left hypochondrium.

When bleeding from a wound kidneys suturing of small wounds that do not penetrate into the cavity system is performed. For more massive wounds, pole resection or wedge resection is indicated, supplemented by nephropyelo- or pyelostomy for wounds penetrating the pyelocaliceal system. Nephrectomy is performed for central ruptures or irreparable damage to the vessels of the pedicle, and the presence of a second kidney must first be ensured. Be sure to perform drainage of the retroperitoneal space.

When ureteral injury a mandatory audit is carried out throughout its entire duration. In this case, either suturing of a small (up to 1/3 of the circumference) wound defect is performed, or resection of the damaged edges and anastomosis in the absence of tension. It is advisable to use a ureteral catheter (stent) during suturing and resection of the ureter. In case of extensive damage and the impossibility of restoring the integrity of the ureter, either the central end of the ureter is removed to the abdominal wall, or unloading pyelo-, pyelonephrostomy is performed. In all cases, the retroperitoneal space is drained.

Bleeding from small superficial wounds pancreas stop by stitching. In such cases, it is sufficient to drain the cavity of the omental bursa with a tube, which is passed along the lower edge of the gland from head to tail, bringing it out retroperitoneally under the splenic flexure or primary department colon to the left side wall of the abdomen along the mid-axillary line. To carry out inflow and outflow drainage, a second tube is additionally inserted into the hermetically sutured omental bursa, which is passed from the right hypochondrium towards the first, through the gastrocolic ligament. In case of extensive wounds of the head or the inability to stop bleeding from the wound of the pancreas, tamponade and marsupialization are performed - suturing the gastrocolic ligament to the edges of the surgical wound. For complete ruptures distal to the passage of the mesenteric vessels, resection of the body or tail of the pancreas is acceptable. Parapancreatic tissue should always be infiltrated with a 0.25% solution of novocaine with antienzyme drugs (contrical, gordox, trasylol). In case of severe damage to the pancreas, the operation must be completed with nasogastrointestinal drainage and unloading cholecystostomy.

In case of injury stomach the crushed edges of the wound are sparingly excised and the wall defect is sutured in the transverse direction. The operation is completed with mandatory drainage of the stomach for the purpose of decompression within 3–5 days. IN in rare cases in case of extensive damage to the organ, its marginal (atypical) resection is performed.

Wounds on the anterior wall duodenum, covered with peritoneum, sutured in the transverse direction; when suturing a large wound defect (up to ½ intestinal circumference), a unloading gastrojejunostomy should be applied. If damage to the retroperitoneal part is detected, the intestine is mobilized according to Kocher, the detected wound hole is sutured, and the retroperitoneal space is drained with a tube. In case of pronounced narrowing and deformation of the intestine as a result of suturing, the operation of choice is the operation of disconnection (diverticulization) by suturing and peritonization of the gastric outlet and applying a gastroenteroanastomosis. Plastic surgery of an extensive duodenal defect with a loop of small intestine (or Roux-en-Y) is allowed; accordingly, between the adducting and efferent sections of the intestinal loop, a unloading entero-enteroanastomosis is applied according to Brown, and with the Roux technique, the continuity of the small intestine is restored using the “end-to-side” technique. The retroperitoneal space is drained, and a nasogastroduodenal tube is inserted into the intestinal lumen.

At minor damage gallbladder After surgical treatment of the wound, the defect is sutured and cholecystostomy is performed. In case of extensive damage, cholecystectomy is performed, and in case of concomitant liver damage, it is necessary to use drainage of the common bile duct through the stump of the cystic duct according to Halstead. In all cases, the subhepatic space is drained with a tube.

For minor damage extrahepatic bile ducts after suturing the wound defect, a cholecystostomy is applied, or cholecystectomy and drainage of the common bile duct is performed through the stump of the cystic duct according to Halsted, or external drainage of the common bile duct is performed using a T-shaped drainage. Drainage of the subhepatic space is mandatory.

Surgical tactics for injuries of the small and large intestines depend on the nature of the injury, the severity of blood loss, the presence and phase of peritonitis.

In case of injury small intestine wound suturing or bowel resection is used. The indication for suturing is the presence of one or more wounds located at a considerable distance from each other, when their size does not exceed the semicircle of the intestine. Resection of the small intestine is indicated for defects of its wall larger than a semicircle, for crushes and bruises of the intestine with impaired viability of the wall, for separation and rupture of the mesentery with impaired blood supply, for multiple wounds located in a limited area and a complete break in the intestine. The imposition of a primary anastomosis after resection of the small intestine is permissible in the absence of peritonitis, as well as after resection of the small intestine, when the danger to the life of the wounded from the formation of a high intestinal fistula exceeds that in the event of failure of the anastomotic sutures. In conditions of diffuse peritonitis in the toxic or terminal phase, an anastomosis is not applied to the small intestine, but the adducting and efferent ends of the small intestine are brought out to the abdominal wall in the form of fistulas. The operation after interventions on the small intestine (suturing several wounds or resection) is completed with its mandatory drainage with a two-channel silicone probe. Preference should be given to nasogastrointestinal intubation, retrograde drainage of the small intestine is preferable when removing a caudal enterostomy.

In case of injury colon the presence of a wound of more than ½ of the circumference of the intestine, destruction or disruption of the blood supply to a segment of the intestine serves as an indication for resection of the damaged segment and the formation of a single-barrel unnatural anus from the afferent section of the intestine; the efferent end of the intestine is plugged according to Hartmann, or it is brought to the abdominal wall in the form of a colonic fistula. The presence of diffuse peritonitis is a contraindication to suturing even a small wound defect; in such cases, it is permissible either to intersect the lumen of the intestine and its mesentery at the site of injury and perform Hartmann’s operation, or to remove the movable damaged area in the form of an unnatural anus like a “double-barreled shotgun.” Suturing is permissible only in the presence of an isolated small (up to 1/3 of the circumference of the intestine) wound, the absence of massive blood loss, as well as severe damage to other organs and anatomical areas; when there is doubt about the final outcome or larger size wound defect (up to ½ intestinal circumference), extraperitonealization of the mobile part of the colon with a sutured wound is indicated. Extraperitonealization refers to the temporary removal through a separate incision of the abdominal wall of a loop of the colon with a sutured wound that is placed under the skin; with a successful postoperative course, after 10 days the bowel loop is immersed in the abdominal cavity; with the development of failure of the intestinal sutures, a colonic fistula is formed. If the mesoperitoneal section is damaged, either the wound is sutured and a discharge proximal diverting colostomy is applied, or the intestinal lumen and its mesentery are crossed at the site of injury, mobilization is performed, and Hartmann's operation is performed. For extensive injuries of the right half of the colon, it is permissible to perform right hemicolectomy:. the application of a primary ileotransverse anastomosis is indicated in the absence of pronounced inflammatory changes in the abdominal cavity, characteristic of the toxic or terminal phase of peritonitis and stable hemodynamics; in other situations, the operation is completed with an ileostomy. Removal of a damaged segment of the colon with an extensive wound onto the abdominal wall is not recommended due to the highest mortality rate.

When wounded intra-abdominal rectum There are 2 options for operational assistance. For a small wound the wound defect is sutured and, from a separate incision in the abdominal wall in the right iliac region, the unnatural anus is applied to sigmoid colon(in the form of a “double-barreled shotgun”). At extensive wounds rectum a resection of the nonviable area is performed and the adducting end of the intestine is brought to the anterior abdominal wall in the form of a single-barreled unnatural anus; the outlet end is sutured tightly (Hartmann operation). In case of injury to the extraperitoneal rectum an unnatural anus (in the form of a “double-barreled shotgun”) is placed on the sigmoid colon. The efferent part of the rectum is washed with an antiseptic solution, after which the ischiorectal space is opened using perineal access; if possible, the wound opening is sutured or the sphincter is restored; Drainage of the perirectal space in case of extraperitoneal injury is mandatory. It is better to use a double-lumen tube, which is brought to the damaged area.

In all cases, operations on the colon should end with decompression of the gastrointestinal tract. Preference should be given nasogastrointestinal intubation using double-lumen silicone probes. When applying an ileo- or cecostomy, retrograde drainage of the small intestine is performed through the removed intestinal fistula. Simultaneous drainage of the colon through the anus with a silicone probe (single- or double-lumen) is mandatory, especially in cases of suturing a defect in the intestinal wall or applying a primary anastomosis. At the end of the operation, devulsion of the anus is performed.

For small intraperitoneal bladder injuries After surgical treatment of the wound, it is sutured with double-row sutures without capturing the mucous membrane. After this, bladder drainage is established with a permanent catheter. In the case of extensive and multiple wound defects, cystostomy and drainage of paravesical tissue are performed according to Buyalsky-McWhorter (through the obturator foramen) or Kupriyanov (under the symphysis pubis). At extraperitoneal bladder injuries make extraperitoneal access to the bladder, and, if possible, suturing wound defects. The operation is completed by applying a cystostomy and draining the paravesical tissue.

An important point surgical stage treatment is sanitation of the abdominal cavity. There are primary and final sanitation. The primary is carried out after evacuation of exudate and intestinal contents from the abdominal cavity, the final - after eliminating or limiting the source of peritonitis. An oxygenated (0.06%-0.09%) or ozonated (4–6 mg/l) isotonic sodium chloride solution has the best bactericidal properties, however, depending on the equipment and capabilities of the military medical institution, a sterile one can be used for lavage of the peritoneal cavity saline or antiseptic solutions: furatsilina (1:5000), chlorhexidine (0.2%).

Each laparotomy for a penetrating abdominal wound should end with drainage of the abdominal cavity. Drains are carried out through separate incisions (punctures) of the abdominal wall, and one of them must be installed in the pelvic cavity.

Surgical wounds of the anterior abdominal wall after laparotomy are sutured tightly. If a laparotomy is performed against the background of diffuse peritonitis, severe intestinal paresis, or the need for repeated sanitation of the abdominal cavity, suturing of the aponeurosis is not performed, but only skin sutures. After this, surgical treatment of the entrance and exit wounds is performed.

After the operation, the wounded are placed in the intensive care ward to continue treatment with the participation of an anesthesiologist-resuscitator, and after awakening, without an endotracheal tube and with natural breathing restored, they are transferred to a hospital ward. In the first 2–3 days of the postoperative period, parenteral nutrition by intravenous administration of protein solutions (plasma, albumin), concentrated glucose solutions (20–40%) with insulin and vitamins with a total volume of up to 4–6 l/day. In subsequent days, the volume of infusions is reduced and gradually switched to enteral nutrition. In case of intestinal paresis, constant aspiration of gastric and intestinal contents through probes is provided, epidural anesthesia is performed, and intestinal function is stimulated.

Antibiotics are administered intramuscularly, intravenously, endolymphatically and additionally intraperitoneally through installed drainages.

In some cases, there is a need to perform early (after 12–24 hours) programmed relaparotomy, the purpose of which is a control examination of internal organs and sanitation of the abdominal cavity. Indications for such an operation are: performing a primary operation against the background of diffuse purulent peritonitis, forced use of methods to temporarily stop bleeding, a high probability of failure of the applied intestinal sutures.

After surgery, those wounded in the stomach are not transportable for 7–10 days if evacuation is carried out by road, and up to 3–4 days - by air.

The most common complication (more than 60% of the total number) in those wounded in the abdomen in the postoperative period is peritonitis. Postoperative peritonitis most often develops as a result of failure of intestinal sutures or anastomoses, local limited peritonitis (abscesses) as a result of inadequate sanitation or inadequate drainage of the abdominal cavity. Diagnosis of peritonitis in those wounded in the abdomen is complex and responsible, since the outcome often depends on early detection of the complication. The basis of diagnosis is the deterioration of the general condition, the progression of intoxication and intestinal paresis, which are often supported by x-ray and laboratory data (increased leukocytosis and shift leukocyte formula left). Laparoscopy is highly informative in terms of diagnosing this complication, but we should not forget about the adhesive process and the possibility of additional iatrogenic damage. If peritonitis is detected, an urgent relaparotomy is performed and its source is eliminated with a full range of detoxification measures (forced diuresis, peritoneal and intestinal lavage, enterosorption, endolymphatic administration of antibiotics, drainage of the thoracic duct). In some cases, after relaparotomy, there is a need for programmatic sanitation of the abdominal cavity, the indications for which are the impossibility of performing a thorough intraoperative lavage once. This situation usually occurs when there is significant fecal content in the abdominal cavity. In such cases, after sanitation of the abdominal cavity, only skin sutures are applied to the edges of the surgical wound. These wounded, after stabilization of hemodynamic parameters in the immediate postoperative period, should be transferred to a specialized hospital in the first place.

The next severe postoperative complication in those wounded in the abdomen is early adhesive intestinal obstruction, usually occurs on days 3–5. The clinical picture of obstruction is characterized by the appearance of cramping pain in the abdomen, nausea, vomiting, bloating, cessation of the passage of gas, stool or intestinal contents, and a change in the shape of the abdomen (Val's symptom). In these cases, conservative therapy is first carried out: drainage and gastric lavage, enema, warm compress on the abdomen, sacrospinal, or even better, epidural blockade at the level of the lower thoracic spine. If these procedures do not lead to the desired effect and intoxication increases, they resort to relaparotomy and removal of the obstacle that caused difficulty in the passage of intestinal contents, drainage of the small intestine with a nasogastrointestinal tube.

At eventration, the causes of which are most often peritonitis, suppuration of the surgical wound and errors in suturing the abdominal wall, the wounded person needs urgent surgical intervention. Under general anesthesia, the prolapsed intestinal loops are inserted into the abdominal cavity, intubation of the small intestine, sanitation and drainage of the abdominal cavity are performed. To prevent repeated eventration, the wound is sutured through all layers with mattress sutures, and a wide bandage of a towel or sheet is applied to the abdomen. With diffuse purulent peritonitis surgical wound The abdomen is closed only with skin sutures.

For prevention pneumonia the wounded person should be in bed with the head end raised, breathing exercises are systematically carried out and vibration massage after administration of analgesics.

Specialized medical care those wounded in the abdomen end up in hospitals designed to treat those wounded in the chest, abdomen and pelvis (CHAP). The wounded are mainly delivered to this stage of evacuation, having already received qualified surgical care.

One of the main tasks when providing specialized assistance is the treatment of emerging postoperative complications: diffuse peritonitis, intra-abdominal abscesses, early adhesions intestinal obstruction, secondary bleeding, eventration of internal organs, phlegmon of the abdominal wall and retroperitoneal space, intestinal fistulas and urinary leaks. In the conditions of modern war, wounded people in the abdomen or pelvis, in need of emergency operations and anti-shock treatment, can be delivered to a specialized hospital directly from centers of mass destruction, bypassing the stage of providing qualified medical care.

The TTMZ continues to treat the wounded due to the complications they have encountered: adhesive disease, intestinal and urinary fistulas, etc.

Instructions for military field surgery

Surgery performed no later than 10-12 hours from the moment of injury can save a person with a penetrating abdominal wound and damage to internal organs. If the patient is not provided with full surgical care in a timely manner, then death becomes almost inevitable. In case of a gunshot wound to the abdomen, it is important to quickly and correctly assess the nature of the wound and provide first aid.

Symptoms of non-penetrating wounds

In some cases, non-penetrating gunshot wounds of the abdomen without extraperitoneal organ damage are classified as minor injuries. The lightest ones are when the flight path of a bullet or projectile or their fragments at the end is perpendicular to the surface of the abdomen. In this case foreign body can become lodged in the abdominal wall without damaging the peritoneum. With oblique wounds of the abdominal wall, which can be caused by projectiles or their fragments, there may be severe bruises small or large intestine, followed by necrosis of a portion of their wall and perforated peritonitis. With gunshot wounds of the abdominal wall, symptoms of shock and symptoms of a penetrating abdominal wound may be observed. Therefore, any wound should be considered as potentially penetrating. Wounded people with non-penetrating wounds require urgent evacuation to a medical facility in order to establish the true nature of the injury.

Symptoms of penetrating wounds

In most cases, penetrating abdominal wounds are accompanied by injuries to the abdominal organs (liver, spleen, stomach, intestines, mesentery, bladder, combined with injuries to the spine and spinal cord).

The clinical picture and symptoms of penetrating gunshot wounds of the abdomen are determined by a combination of three pathological processes: shock, bleeding and perforation or through disruption of the integrity of the wall of a cavity or tubular organ (intestines, stomach, bladder), as a result of which a communication is established between the organ cavity and its environment. In the first hours after injury, the clinic of blood loss and shock dominates. After 5-6 hours from the moment of injury, peritonitis develops.

Symptoms of penetrating abdominal wounds: loss of viscera from the wound or leakage of fluids from the wound canal corresponding to the contents of the abdominal organs. In such cases, the diagnosis of a penetrating abdominal wound is established during the first examination.

First aid

In order to perform the correct first aid actions for an abdominal injury, it is necessary to correctly assess the severity and nature of the injury. . Bullet or shrapnel wounds, penetrating the body, cause damage to the body, which has certain differences from other injuries to the body: the wounds are usually deep, often contaminated with tissue fragments, projectiles, bone fragments, and the wounding object often remains inside the body. These features of a gunshot wound should be taken into account when providing first aid to the victim. The severity of the injury should be assessed by the location and type of entrance hole, the behavior of the victim and other signs.

In case of injuries to the abdominal organs, the victim is seated in a semi-sitting position. Prevention of wound infection: disinfect the edges of the wound, apply a sterile napkin. In case of severe blood loss - antishock therapy.

At the slightest suspicion of a penetrating nature of the wound, you must:

• Give a morphine injection.
• Cover the wound with a dry aseptic dressing.
• Give the wounded person absolutely no drink or food.
• To ensure the fastest and smoothest possible transport.

In case of loss of internal organs:

• Cover the entire abdominal wall with an immobilizing (especially if intestinal loops or omentum fall out of the wound) with a wide aseptic bandage moistened with a solution of furatsilin or petroleum jelly. Prolapsed organs should not be placed into the abdominal cavity.
• Place a roll of gauze bandages around the prolapsed organs. Apply an aseptic bandage over the rollers, being careful not to press the prolapsed organs. Apply a bandage to your stomach.
• Apply cold to the bandage.
• Administer analgesics, cardiac agents, tetanus toxoid, and morphine hydrochloride.
• If necessary, wrap the wounded warm blanket.
• Ensure gentle transportation of the wounded on a stretcher.
• Call an ambulance, ensuring that the victim is delivered in a supine position with bent knees, under which a blanket roll should be placed.

Important! It is forbidden to give water or food to the wounded. To quench the feeling of thirst, you need to wet your lips.

Treatment

The most common complications in postoperative period in those wounded in the stomach - peritonitis and pneumonia. The main signs of peritonitis are abdominal pain, dry tongue, thirst, pointed facial features, tachycardia, breast type breathing, muscle tension of the anterior abdominal wall, widespread and sharp pain on palpation of the abdomen, positive symptoms of peritoneal irritation, absence of intestinal peristalsis sounds.

Treatment includes repeated surgery for peritonitis and subsequent conservative treatment, opening of abdominal abscesses, surgery intestinal fistulas and others recovery operations on the gastrointestinal tract.

In case of combined radiation injuries, surgical treatment of gunshot wounds of the abdomen begins at the stage of qualified medical care and is necessarily combined with treatment radiation sickness. Operations must be one-stage and radical, since as radiation sickness develops, the risk of infectious complications increases sharply. In the postoperative period, massive antibacterial therapy, blood transfusions and plasma substitutes, administration of vitamins, etc. are indicated. In case of combined combat injuries to the abdomen, the hospitalization period should be extended.

The prognosis for gunshot wounds to the abdomen is unfavorable.

The content of the article

Frequency of gunshot wounds to the abdomen in general structure wounds in the Great Patriotic War ranged from 1.9 to 5%. In modern local conflicts, the number of abdominal wounds has increased to 10% (M. Ganzoni, 1975), and according to D. Renault (1984), the number of abdominal wounds exceeds 20%.

Classification of abdominal wounds

Abdominal Wound Clinic

Injuries of parenchymal organs

Injuries of hollow organs

Injuries to the kidneys and ureters

Medical care for gunshot wounds to the abdomen

First aid

First aid

First aid

Qualified medical care

Surgery

Specialized medical care

Abdominal injuries are dangerous pathological condition, in which there is a high probability of damage to internal organs. Wounds in the abdominal area, especially penetrating ones, are characterized by severe pain, due to which the patient suffers shock. The abdominal cavity contains large organs and organs, when damaged, it is almost impossible to stop the bleeding, which often leads to death. That is why you should know how first aid is provided for a stomach injury.

Types of wounds

The nature of early medical care largely depends on the type of injury in the abdominal (abdominal) region. Open wounds are characterized by the greatest danger, as they are accompanied by bleeding, penetrating damage to organs, rupture of tissues and blood vessels. In most cases, open abdominal injuries occur due to punctures, cuts, less often animal bites, and gunshot wounds.

With closed abdominal injuries, there is no penetration of a foreign body into the tissue, but this does not mean that the lesion is less dangerous. With severe bruises, rib fractures are possible with further penetration of debris into nearby organs. Also, closed injuries may be accompanied by internal bleeding, ruptures of organs and large vessels.

Contusion of the abdominal wall is considered the least dangerous pathology. With minor injury and no complications, pathological manifestations disappear within 2-3 weeks. There is pain at the site of the impact, and bruising may occur.

Thus, abdominal injuries can be open or closed, and pose a significant threat to the health of the victim.

Clinical picture

Before providing assistance to the patient, it is important to determine the severity of the lesion. To do this, you need to find out about the symptoms that are bothering the patient. Abdominal wounds are accompanied by a wide range of clinical manifestations, with the help of which the nature of the lesion is determined.

Symptoms of abdominal wounds:

• . With open injuries, tissue is damaged, causing bleeding at the site of injury. The color of the blood varies depending on the nature and depth of the wound. With shallow lesions, the blood is usually bright red, indicating a violation of the integrity of the arterial vessels. Excessive hemorrhage indicates damage to parenchymal organs, which include the pancreas, liver, and spleen.
• Pain syndrome. The intensity and localization depend on where the damage is located, whether internal organs. It is important to note that in some patients pain does not occur immediately, which is quite dangerous, since pain may be absent even if an internal organ is damaged and internal bleeding occurs.
• . In the affected area, the skin usually swells and acquires a bluish tint. This indicates a violation of the blood supply in this area. Often occurs with bruises caused by blows with a blunt object, falls, or compression.
• Loss of consciousness. The symptom indicates serious damage to the abdominal organs. Most often, loss of consciousness is caused by violations of the integrity of the liver, as this results in intense bleeding, and the patient’s condition significantly worsens. At the same time, pale skin, cold sweat, and sometimes chills are noted.
• Bloating. Indicates damage to the pancreas. Injury to this organ is a rare occurrence, which usually occurs simultaneously with damage to other abdominal organs. In addition to bloating, the victim may experience tension abdominal muscles, increased heart rate.
• Nausea and... Occurs with almost any abdominal injury. Occur due to functional disorders caused by mechanical impact to internal organs. Vomiting attacks can be repeated, and the consistency and content of the vomit should be taken into account.

In general, abdominal injuries are accompanied by various symptoms, which can be used to determine the severity of the injury.

First aid

Before proceeding to help the victim, you need to call an ambulance. It is recommended to do this even in the absence of symptoms of severe injury or damage to internal organs. It is extremely difficult to diagnose complications on your own, and therefore only a qualified physician can do this. Then they move on to providing assistance to the victim.

Algorithm of actions:

• Getting into a comfortable position. The victim is given the most comfortable body position for him. It is best if the person with the wound lies down. When gagging, be sure to turn the patient's head to the side to prevent suffocation. If the abdominal injury is caused by a fall on a sharp object, the patient should not be removed or repositioned.
• Air access. The patient is provided with an influx of oxygen. If the injury is received indoors, open the windows, thoroughly ventilating the room. It is recommended to remove the victim's clothing if it interferes with normal breathing.
• Maintaining consciousness. It is not recommended that the patient lose consciousness before doctors arrive. It is necessary to maintain him in a conscious state through dialogue. The victim is asked about his symptoms and reassured. This allows not only to preserve the patient’s consciousness, but also to distract him from pain and prevent panic attacks.
• . Before stopping the bleeding, it is necessary to clean the edges of the wounds from possible contamination. It is best to remove dirt from affected tissues using a cotton swab or cotton swab. In this case, it is strictly forbidden to try to place any object into the wound channel in order to assess the depth of the damage.
• Stop bleeding. If there is an open wound, it is necessary to cover it with an antiseptic bandage or lotion. If there are no disinfectants at hand, clothes and clean handkerchiefs are used to stop bleeding. Treat the wound itself antiseptics Not recommended.
• . Giving the victim any anesthetics is strictly prohibited. Reducing pain blurs the overall clinical picture, which can lead to an incorrect diagnosis. In addition, in case of abdominal injuries, it is possible to relieve the victim of pain only with the help of potent drugs.

It is important to remember that a victim with an abdominal injury should never be given anything to drink or eat, even if he asks for it. The load on the internal organs in this state is not acceptable. After taking the measures described above, it is recommended to apply cold to the affected area. This will reduce pain sensitivity and, to some extent, alleviate the victim’s condition before the ambulance arrives.

In general, first aid for abdominal wounds consists of keeping the patient conscious and preventing complications and bleeding.

Injuries with penetration of foreign objects

With open penetrating abdominal injuries, it often happens that a foreign object remains at the site of tissue rupture. These include various tools, reinforced concrete reinforcement, bladed weapons, bullets, nails, and other objects. In this case, the assistance algorithm changes.

First of all, the severity of the victim’s condition is assessed. If the patient's situation is difficult, the first step is to urgent Care, during which doctors are called. In other cases, calling medical personnel is the first stage of providing assistance to the victim.

If the patient has lost consciousness, he is placed on his back, his head is thrown back and turned to the side. In this position, free access is ensured, and vomit, in the event of a reflex urge, leaves the body without obstacles.

Removing a foreign body from the abdomen is strictly prohibited. Firstly, this increases bleeding. Secondly, during extraction, organ damage is possible, which will lead to the death of the victim. If possible, the foreign body can be trimmed a little so that it does not interfere with the transportation of the patient.

If the object stuck in the stomach is long, it is immobilized. This is done using a bandage or gauze. The object is carefully wrapped, and the ends are fixed around the victim’s torso. Before the ambulance arrives, the patient is covered with a warm blanket and his condition is monitored. Giving food and liquids to drink is prohibited.

If the injury is caused by a gunshot, you should pay attention to the presence of a bullet exit hole. If it is detected, an antiseptic bandage or compress is applied in this place, as well as on the inlet. If there are several bullet wounds, each one must be treated.

Prolapse of internal organs

This pathology is possible with large lacerations or cut wounds. First of all, it is assessed how quickly doctors can arrive. If doctors are expected to arrive within 30 minutes, then an ambulance is first called, and after that they proceed to emergency measures.

If organs prolapse, you should not try to place them back into the abdominal cavity. This will most likely lead to infection. In addition, it is impossible to correctly assemble organs inside the abdominal cavity in the absence of special knowledge.

The prolapsed organs are carefully moved closer to each other, so that the area they occupy is minimal. Subsequently, they are placed in a plastic bag or fabric bag and applied near the wound. If it is impossible to isolate the prolapsed organs, they are carefully wrapped in a bandage and tied to the abdominal cavity. When performing any manipulation of organs, do not apply excessive pressure or squeeze them.

After completing the above procedure, the patient is transferred to a sitting position. In the same position, he is transported to the nearest medical facility. Before the doctors arrive, the prolapsed organs are regularly moistened clean water to prevent them from drying out.

Prolapse of organs due to open wounds of the abdomen – serious complication requiring special first aid.

While watching the video you will learn about first aid for abdominal wounds.

Wounds in the abdominal area - serious pathology, which, in the absence timely treatment, leads to the death of the patient. Knowing the rules of first aid significantly increases the likelihood of survival of the victim and prevents irreversible consequences for good health.

Wounds to the abdomen are divided into open and closed. First aid techniques for such abdominal wounds are fundamentally different.

Closed abdominal wounds

Closed wounds can be caused by being hit in the abdomen by hard objects or by falling on the abdomen. Symptoms of the injury may include:

• hematoma due to internal bleeding;
• the victim's complaints about severe pain in the abdominal area;
• pale appearance, nausea;
• presence of traumatic shock.

You can help the victim by applying cold to the stomach and immediately taking him to a medical facility. Delay can lead to the death of the victim due to ruptures of internal organs and profuse abdominal bleeding. It is forbidden to independently give painkillers, food and drink to the victim. In case of severe thirst, it is allowed to wet the victim’s lips with water without getting it into the oral cavity.

Open abdominal wounds

People who can calmly tolerate the sight of someone else's blood and, in some cases, the sight of internal organs, can provide assistance with open (penetrating) abdominal wounds. First aid for an open wound in the abdomen is provided in the following order:

• If possible, the victim should be placed in a lying position. In cases where the victim is fixed on a traumatic instrument (for example, on the peaks of a sharp fence), it is strictly forbidden to remove it yourself! In this case, in addition to the ambulance, you need to call professional rescuers who will separate the traumatic object from the place where it was fixed.
• Try to stop the bleeding. It is impossible to remove foreign objects from the wound; this can lead to increased bleeding and additional damage to internal organs. You can only cover the foreign object with clean materials: a T-shirt, a bandage, tightly twisted cotton wool. If the wound is open and there is nothing in it, then it needs to be closed by applying a loose bandage or covered with a clean napkin. In cases where internal organs fall out of the wound, they should be covered with a clean (if possible sterile) cloth and bandaged with a layer of cotton wool. Trying to set prolapsed organs is prohibited, as the risk of infection or even further injury is very high!
• You cannot give water, food or painkillers to the victim.
• Before the ambulance arrives or when transporting yourself to medical institution you need to talk to the victim, encourage him, try to bring him out of the state of shock. Often in this condition, victims may try to remove a foreign object from the wound or set prolapsed organs - this should be prohibited; if necessary, you can hold your hands.
• Transportation should be carried out in a lying position with legs raised or bent at the knees.

For a penetrating abdominal wound, first aid is provided only with clean hands. Rescuers should wash them with soap or disinfectant solution and only then proceed to stop the bleeding. Otherwise, infection may occur.