Abdominal wall contusion

　　1. Etiology

　　Mostly caused by blunt force (such as a gunstock, a stone) or direct impact of heavy objects (car accidents, heavy object compression, high-altitude fall impact).

　　2. Pathogenesis

　　Under the direct action of external force, the continuity of the local tissue of the abdominal wall is destroyed, the microvessels and lymphatic vessels in the skin, subcutaneous tissue, and even deep tissue are ruptured, blood and lymph leak out, and subcutaneous hemorrhage and swelling occur. In severe cases, blood clots are formed due to the rupture of small blood vessels in the deep tissue.

　　Widespread contusion can lead to large-scale destruction of tissue cells, the release of potassium ions from cells into the blood, which can cause hyperkalemia when absorbed into the blood. Patients may present with abnormal sensations in the limbs, sharp pain, and mild tremors, weakness of the whole body muscles, and severe cases may appear various arrhythmias. Secondly, it is mainly the complications caused by abdominal surgery: including puncture complications (vascular injury and organ injury), peritoneal distension-related complications (subcutaneous emphysema, pneumothorax, and air embolism, as well as complications caused by CO2 absorption), and complications related to energy instruments.

　　I. Surgical complications

　　Including hemorrhage, bladder and ureteral injury, and gastrointestinal injury, etc.

　　II. Other complications

　　Including anesthetic complications, nerve injury, incisional hernia, etc.

　　III. Peritoneal complications related to peritoneal distension

　　1. Factors related to peritoneal complications:

　　(1) CO2 gas entering the extraperitoneal space;

　　(2) Absorption of CO2 gas;

　　(3) CO2 entering the blood vessels.

　　2. Manifestations of peritoneal complications:

　　(1) Subcutaneous emphysema is common and can manifest as a 'crushing' sound of the skin.

　　(2) Pneumothorax can manifest as abnormal respiration or oxygen saturation.

　　(3) Air embolism is rare but a severe complication, often manifested as sudden severe respiratory and circulatory abnormalities or failure.

　　(4) The absorption of CO2 gas generally does not cause complications, but if the patient has cardiac and pulmonary dysfunction, it can cause respiratory acidosis.

　　(5) The absorption of CO2 gas in the peritoneum can cause a local acidic environment, leading to referred pain such as shoulder and rib pain after surgery.

　　Abdominal wall contusion precautions:

　　After the contusion, the patient should be placed to rest immediately, apply local cold compresses initially to reduce bleeding and exudation, and after 48 hours, hot compresses can be applied to promote the absorption of blood clots. Massage lotions, heparin (Hepatosol) and other drugs can also be used locally for massage to alleviate pain and promote the dispersion and absorption of swelling. If the swelling does not subside, the patient should be sent to the hospital for treatment in a timely manner.

　　Firstly, what should be eaten for abdominal wall contusions?

　　1. Strengthen nutrition by eating high-protein and vitamin-rich diets, such as chicken, lean meat, shrimp, milk, tofu, beans, etc.

　　2. To prevent infection, you can eat needlefish, eels, smelt, chrysanthemum, rapeseed, taro, mung beans, adzuki beans, malan tou, etc.

　　3. Consume easily digestible protein foods such as eggs and fish.

　　Secondly, what foods should be avoided for abdominal wall contusions?

　　1. Eat less greasy food.

　　2. Avoid smoking, drinking, greasy, fried, moldy, and preserved foods.

　　3. Avoid eating spicy foods such as garlic and mustard greens.

　　4. Avoid eating foods that are too sour, spicy, or salty.

　　The diagnosis of simple abdominal wall contusions is not difficult based on local signs of injury. However, due to the weak abdominal muscle tissue in children, it is difficult to resist external force, often causing injuries to abdominal internal organs. Therefore, for abdominal contusions, the key is to determine in a timely manner whether there are injuries to abdominal internal organs and other combined injuries, in order to avoid delays in treatment and severe consequences.

　　Contusions of the abdominal wall are mainly treated conservatively. The patient should rest in bed, apply local cold compresses initially to reduce bleeding and exudation, and after 48 hours, hot compresses can be applied to promote the absorption of blood clots. Massage lotions, heparin (Hepatosol) and other drugs can also be used locally for massage to alleviate pain and promote the dispersion and absorption of swelling. If the blood clot is large, it can be punctured to drain the accumulated blood and apply pressure bandage. If there is still active bleeding, the blood clot may continue to increase, and surgery should be performed as soon as possible to remove the blood clot and ligate the bleeding points. For those with severe contusions, appropriate antibiotic treatment should be used to prevent infection.