Cornwell E E
Division of Trauma-Critical Care, Howard University College of Medicine, Washington, DC.
J Natl Med Assoc. 1992 Nov;84(11):971-2.
The initial challenge facing the traumatologist in the management of bowel and bladder injuries is prompt diagnosis. Intestinal perforations following penetrating trauma are caused by direct penetration or by blast effect, and are most commonly diagnosed by physical examination (signs of peritoneal irritation) or peritoneal lavage. Bowel rupture from blunt trauma is more difficult to diagnose and results from different mechanisms of injury including crushing between the spinal column and the offending blunt object, shearing of the bowel and mesentery at fixed points from sudden deceleration, and rupture secondary to sudden increase in intra-abdominal pressure. Bladder rupture is most commonly seen in association with pelvic fractures, and the diagnosis is made by a well-performed cystogram. This article presents essentials for diagnosis and therapeutic strategies.
创伤外科医生在处理肠道和膀胱损伤时面临的首要挑战是及时诊断。穿透性创伤后的肠穿孔是由直接穿透或爆炸效应引起的，最常见的诊断方法是体格检查（腹膜刺激征）或腹腔灌洗。钝性创伤导致的肠破裂更难诊断，其损伤机制包括脊柱与钝性致伤物之间的挤压、突然减速导致肠道和肠系膜在固定点处的剪切，以及腹腔内压力突然升高继发的破裂。膀胱破裂最常见于骨盆骨折，通过完善的膀胱造影进行诊断。本文介绍了诊断要点和治疗策略。
