Domestic hidden bleeding, i.e. bleeding into closed body cavities, occurs mainly as a result of damage internal organs(liver, lung, etc.), and blood is not released outside.
Exist specific symptoms internal bleeding, knowledge of which can help in timely diagnosis this complex problem.
Such bleeding can be suspected only by changes general condition the victim and according to the symptoms of fluid accumulation in a particular cavity.
Bleeding into the abdominal cavity is manifested by pallor, weak rapid pulse, thirst, drowsiness, darkening of the eyes, fainting. If there is bleeding in chest cavity these symptoms are combined with shortness of breath.
When bleeding into the cranial cavity, signs of compression of the brain come to the fore - headache, impaired consciousness, breathing disorders, paralysis, etc.
IN modern surgery Special attention given to internal bleeding. This is associated with the fact that internal bleeding Compared to open, it is much more difficult to diagnose. And that means the provided health care may be late. Internal bleeding is characterized by the outpouring of blood into the natural cavities of the body or artificially created spaces.
Depending on the amount of blood shed, there are three degrees of bleeding: moderate, moderate and severe.
The main causes include: rib fractures with rupture of intercostal vessels and damage lung tissue, malignant neoplasms internal organs, closed damage liver, spleen, intestines, complications of diseases of organs such as the esophagus (with varicose veins), stomach and duodenum, liver, female genitals.
Main signs of internal bleeding:
- Sticky cold sweat
- Pallor
- Shallow breathing
- Pulse is frequent and weak
Signs and symptoms that are not so pronounced and may only become apparent after some time:
- Blue skin discoloration (hematoma formation in the area of injury)
- Soft fabrics painful, swollen, or hard to the touch
- The victim feels nervous or restless
- Rapid, weak pulse, rapid breathing, nausea or vomiting, decreased level of consciousness
- Pale skin, cool or damp to the touch
- Feeling of unquenchable thirst
- Bleeding from natural orifices of the body (nose, mouth, etc.)
First aid for internal bleeding:
- Provide complete rest
- Give to the affected floor sitting position
- Apply ice or cold water
- Urgently transport the victim to a surgical hospital
Frequency of internal bleeding
Bleeding occurs most often with organ damage gastrointestinal tract. Therefore, it is worth getting acquainted with the methods emergency care gastrointestinal bleeding. In total, there are about 20 diseases, the most significant and common among which are: acute erosive gastritis and stomach cancer varicose veins esophageal veins, cirrhotic liver disease. In the case of stomach cancer, the danger is a disintegrating tumor. The only sign that allows the patient to suspect something is wrong is the darkening of the stool, which occurs due to the coagulated blood contained in it. If vomiting occurs, the vomited masses, again due to coagulated blood, have the color of coffee grounds.
Symptoms of internal bleeding depend on its location and the degree of blood loss. In some cases, it is necessary to distinguish bleeding from the esophagus or stomach from bleeding from a damaged lung. When lung pathology foamy, unchanged scarlet blood is released.
Diseases of the female reproductive system can also cause internal bleeding. Most common cause is a tubal abortion. When breaking fallopian tube blood accumulates in abdominal cavity, creating a feeling of tension and some pressure in the pelvis, especially on the rectum. By the way, bleeding from anus is also quite common. Subsequently, irritation of the peritoneum with blood occurs, which leads to the development state of shock, loss of consciousness, fainting. The pulse in this case becomes frequent and thread-like. Upon examination, abdominal bloating, stool and gas retention are revealed. The patient becomes pale and covered in cold sweat.
Symptoms of hemothorax (blood in the chest)
How to identify and recognize internal bleeding in the chest? If blood accumulates in pleural cavity the development of so-called hemothorax occurs. The pleural cavity is a small space that separates the lungs from the chest. The reasons leading to the development of hemothorax include the following: falls from a height, injuries with damage to the ribs and intercostal vessels, knife wounds, lung cancer, lung abscesses (that is, the formation of abscesses in the lung tissue).
When blood accumulates in the pleural cavity, difficulty breathing occurs when inhaling and when coughing, sharp pains in the chest, general condition disturbance - dizziness, weakness, fainting, pallor skin, increased heart rate and breathing, sweating. Percussion of the patient's chest reveals shortening percussion sound over the affected half, weakening or complete absence breathing. On an x-ray, it is possible to determine signs of mediastinal displacement towards the healthy lung.
Hemarthrosis (blood in the joint cavity)
A common joint lesion is the development of hemarthrosis, which means the accumulation of blood in the joint cavity. A similar condition occurs as a result of injury, less often with hemophilia, scurvy. The anemic symptom is expressed insignificantly, in contrast to the local symptoms. The clinic distinguishes three degrees. With grade 1 hemarthrosis, mild pain is noted, the contours of the joint are slightly smoothed, and the range of motion is not changed. In general, the volume of blood in the joint is up to 15 ml. 2nd degree is characterized by pronounced pain syndrome, which intensifies with loads, smoothness of the joint is noted. There is an increase in the circumference of the affected joint by 1.5 - 3 cm compared to a healthy one. In case of hemarthrosis knee joint Balloting of the patella is observed. The blood content in the cavity is up to 100 ml. At grade 3, the pain syndrome is acute, the outlines of the joint are completely changed. The joint's circumference increases to 5 cm, and mobility is severely limited. Blood volume is more than 100 ml.
General symptoms
Thus, there are signs of bleeding that occur in any case, regardless of the source of the bleeding. TO early signs include: pallor of the skin and visible mucous membranes, cold sweat, general weakness, dizziness, darkening of the eyes, if the lungs are affected - cough with streaks of blood, if organs are involved in the process digestive system- bloody vomiting or bloody diarrhea, symptoms of peritoneal irritation, which occurs when internal organs (spleen, liver, kidney) rupture. With moderate bleeding, a number of symptoms may be either mild or not appear at all
In other words, bleeding leads to the development of anemia. In addition to the above symptoms, anemia is manifested by increased heart rate and hypotension, that is, a decrease blood pressure. The changed parameters directly depend on the degree of blood loss: with moderate - pulse no more than 75 beats per minute, systolic pressure drops to 100 mm Hg. Art.; with average - the pulse rises to 100 beats per minute, blood pressure decreases to 90-80 mm Hg. Art.; in severe cases, the pulse rises to 120-140 beats per minute, systolic blood pressure drops below 80 mm Hg. Art.
Diagnostics
In case of combined trauma, laparocentesis is performed; it is a simple, fast, affordable and gentle method for diagnosing injuries to the abdominal organs and internal bleeding. An ultrasound of the abdominal organs is also sometimes performed.
An important point in confirming the diagnosis is laboratory research blood. The analysis reveals a decrease in the number of red blood cells, the amount of hemoglobin and a drop in hematocrit.
If such symptoms and diagnostic data are detected, it is necessary to immediately identify the cause of the underlying disease and begin treatment. It should be remembered that the earlier the cause of internal bleeding is identified, the more effective and rapid the recovery process will be.
Internal bleeding is one of the most dangerous species bleeding requiring immediate hospitalization.
Save on social networks:Violation of the integrity of blood vessels in most cases leads to the development of bleeding, which can be both external and internal. And if in the first case such a violation is easy to notice and can be eliminated on your own, then bleeding of internal organs can pose a serious threat to life and health. Patients suspected of having such a disorder require urgent hospitalization, adequate diagnosis and properly selected treatment. The topic of our conversation today will be abdominal bleeding, symptoms, causes, and what first aid the victim needs.
Bleeding into the abdominal cavity is the leakage of blood into the peritoneal cavity or into the retroperitoneal area. This condition develops as a result of a violation of the integrity of the blood vessels or organs located here (parenchymal or hollow).
Why does bleeding occur in the abdominal cavity, what causes it?
Internal bleeding of the abdominal cavity can be caused by traumatic or non-traumatic factors.
So similar pathological condition may develop due to mechanical injury chest or abdominal injury. Moreover, it can be caused by both closed wounds (received from impact and compression), and open ones (caused by a gunshot or stab wound, and various injuries during abdominal surgical interventions).
Bleeding into the abdominal cavity can be caused by traumatic rupture of parenchymal or hollow organs digestive tract And genitourinary system. It may occur in response to a rupture blood vessels located in the folds of the peritoneum, as well as in the thickness of the mesentery or in the large omentum. If bleeding into the abdominal cavity develops during surgical interventions, in most cases it is explained by the slippage of a ligature that was placed on the vessels of the mesentery or on the stumps of the operated organs.
If bleeding into the abdominal cavity is of non-traumatic origin, it can occur completely spontaneously, as a complication of a number of diseases or pathological processes occurring in the internal organs. This pathological condition often develops with tumor lesions of the peritoneal organs, with reduced blood clotting. It can be caused by an ectopic pregnancy, rupture of an aortic aneurysm (located in the abdominal region), rupture of the spleen, and rupture of a cyst or ovarian apoplexy.
How does bleeding into the abdominal cavity manifest, what are its symptoms?
The manifestations of bleeding into the abdominal cavity depend on the severity of blood loss - its intensity, duration and volume.
Symptoms of intraperitoneal bleeding include pale coloration of the skin and mucous membranes. The patient is concerned about severe general weakness and a feeling of dizziness. Cold sweat appears on the skin, blood pressure levels drop sharply. Severe tachycardia is also observed - the pulse rate can fluctuate from one hundred and twenty to one hundred and forty beats per minute. Pathological processes make themselves felt by local and diffuse abdominal pain, which significantly intensifies during movements. A fairly common manifestation of bleeding into the abdominal cavity is the patient’s attempts to take a sitting position.
If accumulated blood irritates the diaphragmatic peritoneum, the pain may well radiate towards the chest, as well as to the area of the scapula and shoulder. If bleeding occurs in the retroperitoneal space, back pain occurs.
If the bleeding is profuse, the pain becomes intense. The patient may well lose consciousness, and acute massive blood loss is fraught with the development of collapse.
How does bleeding into the abdominal cavity stop, what is first aid?
If you suspect the development of bleeding into the abdominal cavity, you must immediately call ambulance. The victim must be laid down. Cold should be applied to the site of suspected bleeding - the best option There will be an ice pack, but you can use another cold compress. It should be applied for fifteen minutes, then take a break for a couple of minutes. This pause will help avoid hypothermia.
When providing first aid, it is necessary to ensure that the victim has a sufficient supply of fresh air– open the window, free the area of the neck and chest, because blood loss occurs oxygen starvation.
If bleeding into the abdominal cavity is suspected, as well as if bleeding is suspected, it is extremely important to prohibit the patient from moving and coughing. Transportation to a medical facility should be carried out exclusively in a stationary state.
Of course, bleeding of this kind, as well as bleeding, is a contraindication for taking any liquid or food.
Under no circumstances should you warm the affected area. It is also prohibited to give enemas, give the patient a laxative, or administer medications that can stimulate cardiac activity.
The prognosis for bleeding into the abdominal cavity depends on the cause of the disorder, its complexity and the timeliness of seeking medical help. Emergency surgery allows you to determine the source of bleeding, stop it and repair existing damage.
Thus, bleeding into the abdominal cavity is extremely dangerous condition requiring immediate first aid. Any delay, as well as attempts at self-medication, are fraught with serious complications and even death.
Traditional treatment
Recipes traditional medicine will not help stop bleeding into the abdominal cavity. However, they are able to play a role in its prevention and correction of its consequences.
Just as it shows medical practice, bleeding into the abdominal cavity can be caused by decreased blood clotting.
To increase blood clotting, healers advise using common knotweed, also known as bird knotweed. Brew a tablespoon of dried and crushed herbs with a glass of just boiled water. Infuse the medicine under the lid for half an hour. Take the strained drink one tablespoon three times a day.
Can be used to increase blood clotting. So you can brew a tablespoon of dried herb with one glass of just boiled water. Keep this medicine in a water bath for ten minutes, then cool and strain. Take the prepared decoction one tablespoon four to five times a day shortly after meals. Usually healers advise drinking it for four to five weeks.
You can improve blood clotting by an order of magnitude with the help of yarrow. Brew a couple of teaspoons of dried herb with a glass of just boiled water. Infuse this medicine for an hour, then strain. Take the prepared infusion, a quarter glass four times a day.
To increase blood clotting, healers also advise using marsh cudweed. Brew a tablespoon of well-chopped raw materials with a glass of just boiled water. Infuse this medicine for half an hour, then strain. Take the prepared infusion one tablespoon four to five times a day.
It is worth noting that traditional medicine has certain contraindications for use. They are also capable of causing side effects. Therefore, the advisability of their use should be discussed with your doctor.
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The materials are published for informational purposes only and are not a prescription for treatment! We recommend that you consult a hematologist at your medical institution!
Internal bleeding is a situation in which heme is poured into the body cavities, as well as into the spaces between organs and tissues. Most diseases manifest themselves as pain. With internal bleeding, this symptom is absent, and other signs do not appear immediately. This makes timely diagnosis difficult.
Symptoms of internal bleeding become noticeable only when significant damage has already been caused to the health, posing a great threat to the life of the patient.
Provoking factors
Internal hemorrhage occurs either due to trauma or as a result of a chronic process.
Deadly post-traumatic internal bleeding of the abdomen develops when receiving blunt trauma when the liver or spleen, intestines or omentum are damaged.
In case of rib fractures with injury to the pleura and blood vessels, pleural blood loss occurs.
Craniocerebral injuries make internal bleeding of the skull likely.
Important! Blood entering the joint cavity, which may be caused by a fracture or bruise, does not pose a clear threat to life, but causes significant harm to health.
The causes of chronic internal bleeding are erosion of the walls of blood vessels as a result of the development of neoplasms, chronic diseases, such as ulcerative perforations of the intestines, gastra, varicose veins gulam, gynecological diseases: ovarium ruptures, ectopic pregnancy, graviditate and genus pathologies.
Symptoms and signs
TO general symptoms hemorrhages inside organs include:
- weakness and malaise,
- fainting, dizziness,
- excessive paleness of the skin,
- apathy,
- lowering blood pressure,
- tachycardia.
Important! Internal bleeding threatens the possibility of developing a pre-shock state. His harbingers are considered extreme thirst, weakness, state of anxiety. The skin turns pale and cold, the pulse becomes rapid and thready, breathing becomes shallow and uneven.
Specific symptoms arise in connection with the place of bleeding and shedding of blood: into the chambers or into the tissues.
Signs of internal bleeding in the abdominal cavity:
- bloating. It becomes painful, hard;
- blood in feces.
Internal hemorrhage in the urinary organs is detected by the appearance of blood in the urine. When blood accumulates in the heart sac, symptoms of cardiac tamponade, cyanosis, and an increase in venous pressure appear.
The outpouring of blood into the pleural cavity produces compression of the lung, which is detected by shortness of breath and confirmed by the absence of respiratory sounds during auscultation.
The release of scarlet heme from the anus indicates hemorrhoidal inflammation.
The types and signs of internal bleeding are presented in the table:
|
Symptom |
|
|
Bleeding into the abdominal cavity caused by organ ruptures |
2. Specific: “Vanka-Vstanka” sign. If a person lies down, pain in the shoulder appears; if he gets up, the pain disappears. On palpation, abdominal pain is felt. |
|
Bleeding in the pelvis. Ruptures of the uterus and ovarium |
1. General: pain, discomfort lower abdomen. 2. Specific: pain on palpation in the area of the pubic bones, with in serious condition"Vanka-Vstanka" sign |
|
Bleeding into the retroperitoneal space, with ruptures of the kidneys and abdominal aorta |
1. General: dizzy, weakness, low blood pressure, tachycardia, pale, cold skin. 2. Specific: lumbar pain. When you knock on the lower back, the pain intensifies. |
|
Bleeding in the gastric and duodenum |
1. General: dizzy, weakness, low blood pressure, tachycardia, pale, cold skin. 2. Specific: vomiting with heme or “coffee sediment”, Brown; bloody diarrhea, feces color black or dark cherry; no pain. |
Diagnostic tests
If internal bleeding is suspected, the following general measures are taken:
- Detailed inspection. They check the pulse, blood pressure, listen to the chest, palpate and tap the abdominal cavity.
- Hematological studies.
Specific diagnostic methods are carried out taking into account the preliminary diagnosis:
- rectal examination;
- esophagogastroduodenoscopy;
- colonoscopy;
- bronchoscopy;
- cystoscopy;
- sigmoidoscopy.
In case of hidden hemorrhages, pay attention to the general syndrome of internal bleeding: dizziness, weakness, hypotension, tachycardia, coldness and pale skin.
Important! An objective sign blood entering the lung is the disappearance of the lower border of the organ on the x-ray.
When diagnosing bleeding in abdominal cavity Laparoscopy is used, and intracranial hematoma is identified by echoencephalography.
Primary care
Important! The main thing is to get the patient to the clinic as quickly as possible. First aid is to ensure peace.
If the presence is assumed, the patient is provided with a semi-sitting position. When internal bleeding occurs in other places, before emergency help arrives, the patient should be laid on a leveled surface and cold applied to the area possible bleeding. Do not apply heat or give medications to support the heart.
Methods to stop bleeding
Patients are hospitalized in a hospital. Select a department based on the source of bleeding: traumatology, thoracic, neurosurgical, gynecological or general surgery. The first concern at the first stage is how to stop the bleeding.
The video shows how to provide first aid
In some cases, tamponade helps. In others - cauterization of the bleeding area. However, most often it is required surgery under anesthesia.
Or, as it is called in medical practice, hemoperitoneum– bleeding into the abdominal cavity or retroperitoneal space associated with damage to organs and blood vessels located in this area. Most often, hemoperitoneum is caused by damage to vessels located in the omentum, mesenteries, folds and ligaments of the peritoneum. As for organs, in most cases the pancreas, liver and spleen are affected.
Intra-abdominal bleeding is a deadly condition. But if you know its main symptoms and take timely measures, complications can be avoided.
Causes
All causes of intra-abdominal bleeding can be divided into two main groups. The first includes traumatic causes:
- chest injuries (for example, fractures of the lower ribs can cause damage to internal organs from bone fragments);
- blunt abdominal injuries caused by compression, falls, or strong blows;
- gunshot or knife penetrating wounds to the abdominal area;
- damage after certain operations (gastric or liver resection, nephrectomy, appendectomy, cholecystectomy) associated with complications, slipping of ligatures used for ligating blood vessels, or surgical errors.
Non-traumatic causes mainly include complications of diseases of internal organs:
- rupture of aortic aneurysm;
- severe damage or rupture of the fallopian tube ectopic pregnancy;
- ruptures of cysts of internal organs;
- ovarian apoplexy;
- long-term use of drugs that reduce blood clotting (fibrinolytics or anticoagulants);
- diseases accompanied by a significant decrease in blood clotting (these include: hemorrhagic diathesis, obstructive jaundice, malaria).
Symptoms
Symptoms of intra-abdominal bleeding will depend on its intensity, the location and size of the damaged vessels or organs, as well as the nature of the damage. So, with minor bleeding, the manifestations will be blurred and unexpressed, and with severe and sudden bleeding, they will be obvious and acute.
Possible following signs hemoperitoneum:
- general weakness, loss of strength, muscle atrophy;
- blanching of the mucous membranes of the skin;
- increased sweating;
- increased heart rate (sometimes up to 120 or even 140 beats per minute);
- dizziness;
- darkening of the eyes;
- fainting or shock;
- pain in the area of the damaged organ (such pains are called abdominal, they are pronounced, can radiate to the shoulders, chest, shoulder blades or back and force the patient to take a sitting position, which alleviates the condition);
- loss of consciousness;
- The abdominal cavity is soft, not compacted.
For more information about symptoms and first aid, watch the following video:
Diagnostics
If hemoperitoneum is suspected, the patient must be urgently taken to the hospital for diagnosis. accurate diagnosis and provision of medical care. The specialist will examine the patient. By palpation, the doctor will determine the possible nature and location of the damage. But to clarify the diagnosis you will need diagnostic procedures. The most complete picture is revealed by:
- ultrasonography,
- radiography,
- as well as diagnostic laparoscopy.
Blood tests can also be informative, allowing you to determine the level of hemoglobin (with blood loss it will decrease), hematocrit and other indicators.
Treatment
If intra-abdominal bleeding is suspected, the patient should be immediately placed on a flat horizontal surface. Moving before doctors arrive is contraindicated. Cold may be applied to the abdominal cavity. Ingestion of liquids or food is strictly contraindicated.
Action should be taken immediately and intensive care. It includes resuscitation, antihemorrhagic and antishock measures:
- infusion of blood substitute solutions,
- administration of analeptics (these drugs have a stimulating effect on the vasomotor, as well as respiratory centers brain),
- reinfusion (collection of blood spilled into the retroperitoneal space or abdominal cavity and its re-infusion).
Also in most cases it is required surgical intervention, the purpose of which may be to restore the integrity or remove damaged organs, as well as ligation of blood vessels.
Complications
With significant blood loss there is a risk of death. But even if the bleeding has stopped, an infection can develop, which in most cases leads to peritonitis - inflammation of the membranes covering the internal organs and lining the abdominal cavity.
Prevention
To reduce the risk of developing intra-abdominal bleeding, you should undergo routine examinations on time and treat any diseases of the internal organs, as well as consult a doctor in case of injuries. It is extremely important to detect intra-abdominal bleeding in time and take the necessary measures.
Intra-abdominal bleeding may be a consequence of abdominal injuries, thoracoabdominal injuries, as well as a complication of various pathological processes in the organs of the abdominal cavity or retroperitoneal space. Occurs when the integrity of blood vessels is disrupted abdominal wall, omentum, intestinal mesentery and parenchymal organs(liver, spleen, pancreas), ovarian apoplexy, impaired ectopic pregnancy, rupture of aortic aneurysm, etc. V. k. can also develop after operations on the abdominal organs due to decreased blood clotting (for example, with obstructive jaundice), slipping or cutting through ligatures applied to the vessels of organs, especially parenchymal ones. As a result of V. c., an accumulation of blood occurs in the abdominal cavity (). Clinical picture V. k. depends mainly on the intensity and duration of bleeding, the volume of blood loss (Blood loss) .
With profuse V. to. a picture of acute hemorrhagic shock - fainting or motor, pallor of the skin and visible mucous membranes, cold, adynamia, dizziness, darkening of the eyes (up to 120-140 beat. in 1 min) and arterial. When examining the abdomen of a patient with V., they look for signs of injury, hematoma, or abrasion. The anterior part is soft on superficial palpation, moderately painful, and has limited participation in breathing. With deep palpation you can find in the area damaged organ. A characteristic feature V.K. is positive Blumberg - Shchetkin with a soft anterior abdominal wall (see Acute abdomen) .
In the sloping parts of the abdomen, there may be dullness of percussion sound, painful, bowel sounds weakened or not heard. During digital examination of the rectum, overhang of its anterior wall can be determined; at vaginal examination- flattening of the arches, their pain, overhang posterior arch. Due to irritation of the diaphragmatic peritoneum by the gushing blood, it occurs in the area of the shoulder girdle and scapula, tends to assume a sitting position, which reduces abdominal pain (symptom of vanka-stand-up). A blood test reveals a decrease in hematocrit. A decrease in hemoglobin and the number of red blood cells is usually detected several hours after the start of bleeding. If V. is suspected, the patient should be urgently hospitalized. When erased clinical manifestations V. to. the posterior vaginal fornix is of great diagnostic importance (see Gynecological examination) and with the introduction of a groping catheter, which allows detection in the abdominal cavity. A study of the hemoglobin level of this blood makes it possible to judge the intensity and duration of V. to. Laparoscopy plays a leading role in the diagnosis of V. to. .
X-ray examination with V. to. allows only to establish the presence free liquid in the abdominal cavity. Differential is carried out with a retroperitoneal hematoma, hematoma of the anterior wall, with a perforated ulcer of the stomach and duodenum. X-ray examination of a retroperitoneal hematoma reveals expansion of the shadow and blurring of the contours of the lumbar muscles, and with a perforated ulcer - free gas in the abdominal cavity. With a retroperitoneal hematoma and with a hematoma of the anterior abdominal wall, as a rule, there is no free fluid in the abdominal cavity. Careful dynamic monitoring is necessary, measuring pulse rate and value every 1-2 hours, determining the amount of hemoglobin and hematocrit value. Until a diagnosis is made, painkillers and narcotics are contraindicated. In the case of massive V. k., intensive therapy is started without delay (transfusion of fluid and blood substitutes, administration of cardiovascular analeptics), according to indications resuscitation measures. in conditions surgical department includes laparotomy, identifying the source of bleeding and stopping it. During the operation for V. k. no more than 12-24 years old h and in the absence of damage to the hollow organs, it is possible to reinfuse the blood that has poured into the abdominal cavity. with V. K. is always serious. Bibliography: Current problems of hemostasiology. edited by B.V. Petrovsky et al., M., 1981; Jerota D. Surgical examination of the abdominal cavity. from rum., M., 1972; Kochnev O.S. Emergency gastrointestinal tract, Kazan, 1984, bibliogr.; Operative surgery, ed. I. Littmann, trans. from Hungarian, Budapest, 1985; Guide to Emergency Abdominal Surgery, ed. V.S. Savelyeva, M., 1986.
1. Small medical encyclopedia. - M.: Medical encyclopedia. 1991-96 2. First aid. - M.: Great Russian Encyclopedia. 1994 3. encyclopedic Dictionary medical terms. - M.: Soviet encyclopedia. - 1982-1984.
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