• Serious visceral injuries have sometimes been found in patients who at first appeared to have recovered promptly after nonpenetrating abdominal injuries. Thirty such patients between the ages of 9 and 63 years have been classified as to the sources of delayed intra-abdominal hemorrhages following trauma. In three cases the source remained undetermined; in one it was the kidney; in three, the duodenal wall or pancreas; and in three, the liver. In 20 patients, the largest group, the source was the spleen, and 9 of these patients had been beaten or kicked. The finding that delayed hemorrhage from the liver was less frequent than that from the spleen agrees with other reports indicating that when hemorrhage from the liver occurs it is likely to be immediate. Three cases are described in detail to illustrate hemorrhage from the spleen after thoracentesis, hemorrhage from the liver after a fall from a window, and subserosal hematoma of the duodenum after a football game. Needle biopsies were responsible for two instances of slow bleeding from the liver and one instance of hematoma of the kidney. When the diagnosis of delayed hemorrhage with shock is established, the essential treatment is emergency operation to stop the bleeding at its source.
Altemeier WA, Sherman R, Fultz CT. CAUSES OF DELAYED AND OBSCURE INTRA-ABDOMINAL HEMORRHAGE FOLLOWING TRAUMA. JAMA. 1957;163(9):705–708. doi:10.1001/jama.1957.02970440001001
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