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Bowel Rupture

1. Causes

Rapid deceleration or crushing injuries

Tearing in areas where freely mobile bowel isattached to the retroperitoneum

each end of transverse colon

duodeno-jejunal flexure

ileocaecal area

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Bowel Rupture

2. Features

Transverse, linear ecchymosis on abdominal wall (seat beltsign)

Peritoneal irritation due to intra-abdominal bleeding and release

of intestinal content into abdominal cavity Tenderness

3. Investigation

Plain radiograph - presence of free air in peritoneal cavity Abdominal exploration

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Bowel Rupture

4. Management

Simple closure of perforation

Resection if mesentery is lacerated and bowelis not viable

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Renal Trauma

1. Causes Direct blow in the loin

Penetrating wounds (occasional)

Degree of damage varies from slight subcapsularbruising to complete rupture & fragmentation of

kidney /Its avulsion from its vascular pedicles.

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2. Types of closed renal trauma

a)Subcapsular haematoma

b)Laceration

c)Avulsion of one pole

d)Avulsion of renal pedicle

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Renal Trauma

3. Clinical Features Local pain and tenderness

Haematuria

- common finding

Pain on inspiration in abdomen and flank

Associated injury to other viscera (spleen)

Flank discolouration (late sign)

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Renal Trauma

4. Investigation

Urine test: (macroscopic haematuria is usual)

Intravenous urography (IVU): damage ofkidney shown by extravasation of contrastmedium outside renal outline

 /distortion/rupture of renal calyces

Ultrasound: renal tear CT scan: solid visceral injuries

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Intravenous Urogram

Demonstrating extravasation of contrast from the rightkidney, and a functioning left kidney

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5. Management Penetrating injuries

surgical exploration after imaging

Blunt injuries Conservative treatment - bed rest, serial

observation of urine, and clinical charting ofBP & pulse rate

Nephrectomy if

- continued, life threatening bleeding

- persisting severe hypertension

- lack of function in affected kidneyafter several month

Renal Trauma

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Stomach Stomach relatively mobile

Protected on the left by lower part of ribcage from blunt trauma

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 Gall Bladder And Biliary

Rupture of gallbladder  – cholecystectomyshould be performed

Rupture of bile duct is less common thangallbladder

Features of injury are gradual distension ofabdomen with fluid and jaundice

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Bladder rupture

1. Types:

Intraperitoneal rupture

Extraperitoneal rupture

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Bladder Rupture Intraperitoneal 

Follows a penetrating wound (bullet wound) orcrush injury to pelvis when bladder is distended

peritonitis with generalized abdominal pain, rigidity

Extraperitoneal

Fracture of pelvic bone and during herniaoperation or cystocele repair

Painful swelling arise from the pelvis

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2. Investigations CT scan: demonstrates extravasation & associated pelvic

injury

Cystography: confirm rupture

Urethrography: urethral injury

3. Treatment

Intraperitoneal : suture and drainage

Extraperitoneal :

(a) small: urinary catheter drainage(b) large: repair with drainage of retropubic space

and antibiotic therapy

Bladder Rupture

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Cystogram showing intraperitoneal bladder rupture.The bladder outline is compressed due to surrounding

haematoma.