Subcutaneous or non-penetrating injuries of the abdominal viscera are of such frequent occurrence, and their early diagnosis so important, that it is somewhat surprising that they are not recognized earlier in the majority of cases than is the rule at present. A study of the early symptomatology of these visceral lesions is therefore desirable.
I shall consider only those injuries resulting from external violence of such character as does not produce any surface trauma of the abdomen, or at least leaves only slight evidence of external injury. I shall also further limit my subject by excluding injuries of the urinary tract.
Penetrating wounds of the abdomen naturally point to and make easy, comparatively speaking, the diagnosis of associated visceral lesions. When the internal injury is not accompanied by external abdominal trauma the diagnosis is usually difficult. Damage to other parts of the body often diverts the attention of the physician
HENRY H. SHERK. INJURIES OF ABDOMINAL VISCERA WITHOUT EXTERNAL SIGNS OF VIOLENCE. JAMA. 1911;LVI(10):718–725. doi:10.1001/jama.1911.02560100010004