Bleeding into the abdominal cavity symptoms. Inpatient medical care

With internal bleeding, blood accumulates in organs and body cavities. It cannot be determined visually!

First aid for internal bleeding:

If there is internal bleeding into the pelvic cavity or abdomen, you can help by pressing the abdominal aorta against the spine with your fist. It is advisable to place a handkerchief or several layers of gauze between the skin and the hand.

In case of gastrointestinal bleeding, the patient is given pieces of ice to swallow.

Do not heat the injured area, give laxatives, give enemas or give medications that stimulate heart activity!

Causes

Internal bleeding is the flow of blood into the body cavity or human organs and into the interstitial spaces. The cause of this condition may be related to injury or chronic pathologies.

The following diseases and conditions can lead to internal bleeding:

injuries with damage internal organs(liver, lungs, spleen);
peptic ulcer duodenum and stomach;
rupture of an internal cyst;
closed fractures;
dissecting aortic aneurysm;
gynecological diseases (ovarian apoplexy, ectopic pregnancy);
varicose veins of the esophagus and stomach;
decaying malignant tumors.

These conditions can be triggered by accidents, strong impacts, falls from a height, active physical exercise, alcohol abuse, generous reception food.

Symptoms

With internal bleeding, the following symptoms develop that require first aid. Clinically, the condition is accompanied by objective ( external manifestations) and subjective (feelings of the victim) symptoms. The first of these includes:

pointed facial features;
pallor of the skin and mucous membranes;
low performance HELL;
hand tremors;
tachycardia (pulse more than 100 beats per minute);
cold sweat, perspiration;
dyspnea;
muscle tension;
cold extremities;
fainting.

Subjective signs:

dizziness;
drowsiness, weakness;
darkening of the eyes;
yawn;
nausea;
noise in the head;
dry mouth;
tinnitus;
nausea, vomiting;
confused consciousness.

With hemorrhage in abdominal cavity there is pain during palpation (palpation) and heaviness in the abdomen, the “Vanka-Vstanka” symptom is the development of pain in the left or right shoulder, neck in a lying position, sitting, the pain disappears, but dizziness appears.

For gastrointestinal bleeding characterized by the absence of abdominal pain, melena (black feces), brown vomit (coffee grounds).

When breaking abdominal aorta, injury to the kidneys and adrenal glands, blood accumulates in the retroperitoneal space, pain occurs in the lower back, and when tapping on this area it becomes unbearable. Red blood cells may also appear in the urine.

When blood leaks into the muscles, bruises and hematomas occur in the area of injury. In this case, the main help is cold.

If bleeding is caused gynecological diseases, then to general symptoms hyperthermia, pain, heaviness, a feeling of fullness in the lower abdomen, pressure on anus, a feeling of swelling of the mucous tissues inside.

Injury to a vessel in the lungs is usually accompanied by a cough, along with which foamy blood or blood streaks come out.

When cerebral bleeding occurs, organ tissues are compressed, resulting in unbearable headaches, vomiting, speech impairment and motor activity, convulsions.

The severity of the condition can be judged by pulse and blood pressure readings. Systolic pressure below 80 mm Hg. Art. and pulse above 110 beats per minute. points to serious condition and the need for assistance and urgent hospitalization. With blood loss of more than 2-3.5 liters, coma develops, followed by agony and death.

Diagnostics

Diagnosing internal bleeding can be quite difficult; for this, first of all, an examination is carried out, measuring blood pressure and pulse, tapping and palpating the abdominal cavity, listening chest. To assess the severity of blood loss and volume necessary assistance perform laboratory research hemoglobin level and hematocrit (volume of red blood cells).

Diagnostic methods depend on the cause internal hemorrhage:

For gastrointestinal pathology: esophagogastroduodenoscopy, digital examination of the rectum, colonoscopy, gastric intubation and sigmoidoscopy;
If the lungs are affected, bronchoscopy;
In case of illness Bladder- cystoscopy.

Ultrasound, radiological and X-ray techniques. If bleeding into the abdominal cavity is suspected, laparoscopy is performed, and for intracranial hematoma, echoencephalography and skull radiography are performed.

Specialized medical care

The victims receive full assistance and undergo treatment in a hospital. The department of which depends on the type of bleeding, the therapy is carried out by doctors of different profiles: gynecologists, thoracic surgeons, neurosurgeons, traumatologists, etc.

Basic goals medical care:

urgent stop of internal hemorrhage;
restoration of microcirculation;
replacement of lost blood;
prevention of empty heart syndrome by replenishing blood volume;
prevention of hypovolemic shock.

In all cases, infusion therapy is performed (the volume depends on internal blood loss): transfusion of polyglucin, saline solution, stabizol, gelatinol, glucose, blood and its preparations (albumin, fresh frozen plasma, red blood cells), plasma substitutes. At the same time, blood pressure, central venous pressure and diuresis are monitored.

If blood pressure does not rise due to infusions, norepinephrine, dopamine and adrenaline come to the rescue. For hemorrhagic shock, heparin, trental, steroid hormones and chimes.

In some cases, internal hemorrhage is stopped by cauterization or tamponade of the bleeding area. But more often it is urgent surgery under anesthesia. If you suspect the development hemorrhagic shock Transfusion measures must be carried out.

At stomach bleeding Resection is indicated; for duodenal ulcers, vagotomy and suturing of the vessel are indicated. The outpouring of blood from the fissure of the esophagus is stopped endoscopically in combination with cold, taking antacids and hemostatic drugs. If the assistance provided does not bring results, the cracks are sutured.

In case of internal bleeding from the lungs, it is necessary to pack the bronchus. The accumulated blood from pleural cavity removed by puncture; in severe cases, thoracotomy with suturing of the site is necessary lung damage or ligation of the vessel. Emergency laparotomy is performed in all cases of ruptures of abdominal organs, and craniotomy is necessary in intracranial hematoma.

For internal gynecological hemorrhages, vaginal tamponade or surgical intervention, sometimes with removal of the ovary, fallopian tube or uterus.

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. Intra-abdominal bleeding may also develop after surgery 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 intra-abdominal bleeding There is an accumulation of blood in the abdominal cavity (hemoperitoneum).

Clinical pictureintra-abdominal bleeding depends mainly on the intensity and duration of bleeding, volume blood loss With profuse intra-abdominal bleeding a picture of acute hemorrhagic shock develops - fainting or motor agitation, pallor of the skin and visible mucous membranes, thirst, cold sweat, adynamia, dizziness, darkening of the eyes, tachycardia (up to 120-140 beat. in 1 min) and arterial hypotension.

When examining the patient's abdomen with intra-abdominal bleeding pay attention to the presence of signs of injury, hematoma, abrasion. On superficial palpation, the anterior abdominal wall is soft, moderately painful, and has limited participation in breathing. At deep palpation You may notice pain in the area of the damaged organ. A characteristic feature intra-abdominal bleeding is a positive Bloomberg-Shchetkin sign with a soft anterior abdominal wall (see. Acute stomach). In sloping parts of the abdomen, percussion sound may become dull, percussion is painful, bowel sounds weakened or not heard. At digital examination the rectum can be determined by overhang of its anterior wall; at vaginal examination- flattening of the arches, their pain, overhang posterior arch. Due to irritation of the diaphragmatic peritoneum by the gushing blood, pain occurs in the area of the shoulder girdle and scapula, the patient strives to take sitting position, which reduces abdominal pain (vanka-vstanka symptom). 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 you suspect intra-abdominal bleeding the patient must be urgently hospitalized. When erased clinical manifestationsintra-abdominal bleeding important diagnostic value have a puncture of the posterior vaginal fornix (see. Gynecological examination) and laparocentesis with the introduction of a groping catheter, which makes it possible to detect blood in the abdominal cavity. A study of the hemoglobin level of this blood makes it possible to judge the intensity and duration of intra-abdominal bleeding. Leading role in diagnosis intra-abdominal bleeding plays laparoscopy. X-ray examination at intra-abdominal bleeding allows only to establish the presence free liquid in the abdominal cavity.

Differential diagnosis is carried out with a retroperitoneal hematoma, hematoma of the anterior wall, with a perforated gastric ulcer and duodenum. X-ray examination of retroperitoneal hematoma reveals expansion of the shadow and blurring of contours 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 observation with measurement of pulse rate and blood pressure every 1-2 hours, determination of the amount of hemoglobin and hematocrit value. Before diagnosis is made, painkillers and narcotic drugs. In case of massive intra-abdominal bleeding immediately begin intensive care(transfusion of fluid and blood substitutes, administration of cardiovascular analeptics), according to indications resuscitation measures. Surgical intervention in conditions surgical department includes laparotomy, identifying the source of bleeding and stopping it. During the operation for intra-abdominal bleeding no more than 12-24 years old h and in the absence of damage hollow organs it is possible to reinfuse blood that has spilled into the abdominal cavity. Forecast at intra-abdominal bleeding always serious.

Bibliography: Actual problems hemostasiology. edited by B.V. Petrovsky et al., M., 1981; Jerota D. Surgical examination abdominal cavity, lane from rum., M., 1972; Kochnev O.S. Emergency gastrointestinal surgery intestinal 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.

Health may deteriorate unexpectedly. And incomprehensible pain in the abdominal area leads to unbearable pain. What was the reason is difficult to say at first. But bleeding into the abdominal cavity is so dangerous that without diagnosing and treating it in a timely manner, a person can die.

The patient may not even suspect that he has internal bleeding in the abdominal cavity. Although it is almost always preceded by serious injuries, under the influence of which blood vessels are separated or simply damaged. Experts highlight the internal traumatic injury vessels. Yes, under the influence strong blow mechanical disconnection occurs. The deformed vessel begins to bleed. As a result serious problems that need to be addressed as quickly as possible.

Another reason why painful separation of blood vessels can occur is chronic diseases: tuberculosis and stomach ulcers. In addition, when oncological diseases Internal bleeding of the abdominal cavity may also open.

One of the main problems internal bleeding is that all the blood does not come out. It simply accumulates inside the organs and begins to put pressure on them. But, if a person has chronic diseases, the progression of which may result in internal bleeding, he should know in advance about potential problems from his attending physician.

Bleeding into the abdominal cavity: symptoms

Most experts are confident that if the patient is aware of how certain abnormalities in the body work and what symptoms they are accompanied by, then he can consult a doctor in a timely manner. Although bleeding into the abdominal cavity does not have the most pronounced symptoms, you can still determine what is happening in it based on the state of your body.

To be more precise, bleeding into the abdominal cavity has the following symptoms:

A sharp decline blood pressure, accompanied by congestion in the ears and unbearable headache.
Darkening of the eyes with temporary loss of consciousness. Fainting state.
Chills and severe weakness.
Pallor skin. In some cases, the dermis becomes almost gray.
The pulse rises sharply.

At first glance, the symptoms seem uncharacteristic and can be attributed to many other conditions of the body. But it is worth noting that the doctor, despite the complexity of diagnosis, can almost instantly, knowing about the patient’s illnesses or his recent injuries, say what caused this condition.

Signs of internal bleeding in the abdominal cavity

If you pay close attention to your health, you can independently notice the main signs of internal bleeding in the abdominal cavity. Symptoms begin to become more severe, and the general condition worsens. But a lot depends on which vessel was damaged and at what speed the bleeding occurs. If this is rapid bleeding and large vessels are damaged, then the person can lose consciousness very quickly. At minor bleeding the symptoms will only increase, and the person will become a little worse. In such cases, the problem can be diagnosed much faster and treatment carried out more effectively.

In many ways, the signs of internal bleeding in the abdominal cavity depend on its type. Each of them has specific symptoms. Therefore, it is worth considering each of them in more detail:

Bleeding occurring in the retroperitoneal space as a result of rupture of the kidneys, aorta, adrenal glands - in addition to the main symptoms, is accompanied by lower back pain. With a slight load on the lower back, the pain begins to intensify.
Bleeding into the free abdominal cavity due to ruptures of the liver and spleen - severe pain upper sections abdomen, especially upon palpation, periodic pain in the right and left shoulder and spine, heaviness in the abdominal area.
Bleeding occurring in the gastrointestinal tract in the presence of chronic diseases occurring in it - the symptoms are very pronounced, vomiting blood, feces are bright red or black, very frequent diarrhea At the same time, there is no pain in the abdomen.
Bleeding arising from the pelvic organs due to ruptures in the ovaries, uterus and fallopian tubes accompanied by severe pain upon palpation in the pubic area, discomfort and pain in the abdomen, pain radiating to the right and left shoulder.

Signs of internal bleeding in the abdominal cavity are many-sided, but they all clearly signal that a person needs to pay special attention to his health and seek immediate help from a specialist.

Bleeding in the abdominal cavity: causes

As sad as it is to admit, a person’s condition can worsen at any moment. Bleeding in the abdominal cavity has very diverse causes, but all of them lead to the fact that you can say goodbye to your health, and maybe your life, forever.

Bleeding in the abdominal cavity has the following causes:

Traumatic: blows, cuts, bruises.
Chronic: rupture of blood vessels in organs susceptible to chronic diseases.
Ectopic pregnancy and pelvic organ diseases.
Chronic diseases of the gastrointestinal tract.
Oncological diseases of the gastrointestinal tract and pelvic organs.
Injuries to the lumbar region.
Excessive physical activity.
Varicose veins in the esophagus and stomach.
Malory-Weiss syndrome.

We must always remember that internal bleeding in the vast majority of cases (except for injuries) occurs under the influence of the development of a chronic disease. Therefore, the patient may even personally understand that his current changes are caused by the active stage of the disease.

Treatment of bleeding into the abdominal cavity

It is very important to properly treat bleeding into the abdominal cavity. First of all, if the patient complains of even a slight malaise and has characteristic symptoms, then you should immediately put him on a bed or other surface. Being in horizontal position Depending on where the pain is localized, it is necessary to apply cooling heating pads. Under no circumstances should they be removed before the ambulance arrives. Under no circumstances should you treat bleeding into the abdominal cavity on your own.

After hospitalization, depending on the nature and intensity of the course, doctors independently decide how bleeding into the abdominal cavity will be treated.

If the case is not complicated and the bleeding has completely or practically stopped and was insignificant, intravenous administration is advisable. saline solutions and taking hemostatic drugs.

In case of active and severe blood loss, surgical intervention is immediately performed in parallel with supportive therapy.

It must be remembered that treatment of bleeding into the abdominal cavity should be carried out on an inpatient basis under the direct supervision of specialists.

Bleeding into the abdominal cavity is a problem that cannot be dealt with on your own. Therefore, a person with chronic diseases must always be on alert in order to understand in a timely manner what his ailment is and take appropriate measures.

One of the most insidious acute life-threatening conditions is internal bleeding. They represent pathological condition, accompanied by the release of blood from the vessels into the free abdominal cavity, retroperitoneal space or hollow organs (stomach and intestines). The whole complexity of the situation is that usually most diseases cause concern in a person in connection with the signaling pain syndrome. With any bleeding there are no such signs. This leaves this problem went unnoticed for a long time. They begin to pay attention to it only when the condition of patients sharply worsens. But there are specific symptoms internal bleeding, knowledge of which can help in timely diagnosis this complex problem.

Signs of internal bleeding

By paying close attention to all changes in the body, you can notice seemingly ordinary changes. Over time, they gradually worsen. Immediate signs of internal bleeding:

Poor health and general weakness;
Dizziness and fainting;
Drowsiness and apathy (lack of interest in anything);
Unnatural paleness of the skin;
A decrease in blood pressure below those figures that are typical for a particular person in normal times ( arterial hypotension);
Increased heart rate (tachycardia).

All of the listed symptoms are general. They are typical for any type of internal bleeding. There is another group of clinical manifestations that relate to specific signs of a particular type of this disease. They will be discussed in other sections of the article.

The only thing worth focusing on is the speed of development and progression of symptoms. Sometimes all the signs grow so quickly and spontaneously that neither the patients themselves nor the people around them can understand what is happening. But it happens that the situation develops gradually with a gradual deterioration of the general condition and worsening symptoms. This option clinical course internal bleeding is more favorable, as it makes it possible to notice threatening symptoms and seek help in a timely manner.

The intensity of internal bleeding and the rate of increase in its symptoms depend on the cause of its occurrence and the diameter of the bleeding vessels. The more large vessel damaged, the heavier it is!

Types of internal bleeding and their manifestations

If we consider this issue globally, we can say that internal bleeding is one in which the spilled blood does not have direct contact with external environment. Therefore, many do not classify bleeding from the stomach and intestines as internal. But, if we take into account that they may not cause specific symptoms for a long time, then it is advisable to consider them in the context of internal ones. After all, the main thing is to suspect a problem as early as possible, and everything else will be clarified during the process of observation and diagnosis in a medical facility.

All types of internal bleeding and their corresponding specific symptoms are given in a visual table.

Type of bleeding	How to spot internal bleeding
Bleeding into the free abdominal cavity (ruptures of internal organs: liver, spleen)	General symptoms (weakness, dizziness, pale skin, arterial hypotension and tachycardia); Heaviness in the abdomen; The “Vanka-Vstanka” symptom is the appearance of pain in the right or left shoulder, neck in a horizontal position. When sitting, the pain goes away, but dizziness occurs; Pain in the upper abdomen on palpation.
Bleeding from pelvic organs(ruptures of the ovaries, uterus and fallopian tubes)	General symptoms; Pain and discomfort in lower sections belly; Pressure on the anus; Pain over the pubis upon palpation; The “Vanka-Vstanka” symptom occurs only with massive bleeding and severe general condition sick.
Bleeding into the retroperitoneal space (ruptures of the abdominal aorta, kidneys and adrenal glands)	Symptoms general. Always expressed moderately; Lower back pain; A positive symptom of tapping is tapping on the lower back causes increased pain.
Gastrointestinal bleeding (diseases of the stomach, small and large intestines, leading to exposure of blood vessels)	Vivid general symptoms; Vomiting blood or brown matter (coffee grounds); Bloody diarrhea, dark cherry or black stools; Lack of any pain in a stomach.

Laparoscopy is the most modern method diagnosis and treatment of internal bleeding

Immediate causes

The following diseases and conditions can lead to internal bleeding:

Closed and open injuries abdomen with damage to internal organs (liver, spleen, mesentery of the small intestine);
Ovarian apoplexy (ovarian ruptures);
Rupture of an ovarian or pelvic cyst (most often occurs during sexual intercourse);
Active physical activity (can provoke ruptures of cystic ovaries or enlarged internal organs);
Injuries of the lumbar region;
Aortic aneurysms that begin to dissect;
Peptic ulcer of the duodenum and stomach;
Ruptures of the mucous membrane of the esophagus (Malory-Weiss syndrome);
and stomach;
Disintegrating tumors of the gastrointestinal tract, abdominal cavity and retroperitoneal space.

There can never be internal bleeding independent disease. They are always either the main manifestation or a complication of a number of pathological conditions.

What is the danger and what to do

It is very important to know how to behave correctly in case of internal bleeding. After all, a person’s life often depends on it. Undifferentiated tactics boil down to the following activities:

Place the patient with the slightest signs internal bleeding. All further actions must be carried out in a strictly horizontal position of the patient;
Cooling the abdomen (ice pack or cold heating pad on the lower abdomen, hypochondrium or lumbar region, depending on the presumed location of the source of bleeding);
Transport the patient in this position to the nearest medical facility.

If you neglect the rules of first aid, this can lead to increased bleeding and massive blood loss. Similar conditions are always very dangerous and pose a direct threat to human life.

In a surgical hospital setting, specialists can choose the following tactics.

Situation	What actions
Minor bleeding with signs of self-stopping and moderate blood loss. The diagnostics revealed no severe injuries and no significant accumulation of blood in the abdominal cavity.	Observation, infusion therapy intravenous administration saline solutions (Ringer, saline, reosorbilact, refortan), hemostatic drugs (aminocaproic acid, etamsylate).
Severe blood loss of any origin, regardless of the causes and damage to organs	Emergency surgery with parallel infusion therapy to maintain the most important vital parameters.

In the vast majority of cases of internal bleeding, emergency treatment is required. surgical treatment. This is the only way to save lives and prevent complications.

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 the vessels of the abdominal wall, omentum, intestinal mesentery and parenchymal organs (liver, spleen, pancreas) is damaged, ovarian apoplexy, disrupted ectopic pregnancy, rupture of an aortic aneurysm, etc. V. k. can also develop after operations on the abdominal organs due to a decrease in 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 ().

The clinical picture of V. to. depends mainly on the intensity and duration of bleeding, the volume of blood loss (Blood loss) . With profuse VK, a picture of acute hemorrhagic shock develops - 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 it can be detected in the area of the 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, percussion sound may be dull, painful, bowel sounds are weakened or cannot be heard. During digital examination of the rectum, overhang of its anterior wall can be determined; during vaginal examination - flattening of the vaults, their soreness, overhang of the posterior vault. 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 the clinical manifestations of V. are erased, the posterior vaginal vault (see Gynecological examination) and the introduction of a groping catheter are of great diagnostic importance, 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 of free fluid 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., intensive therapy (transfusion of fluid and blood substitutes, administration of cardiovascular analeptics) is started without delay, and resuscitation measures are carried out according to indications. in a 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 health care. - M.: Great Russian Encyclopedia. 1994 3. encyclopedic Dictionary medical terms. - M.: Soviet Encyclopedia. - 1982-1984.

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