Osteosynthesis and Trauma Care 2002; 10(2): 64-67
DOI: 10.1055/s-2002-34679
Original Articles

© Georg Thieme Verlag Stuttgart · New York

Primary Treatment of Abdominal Trauma

C. Fialka1 , M. Fuchs2 , C. Sebök1 , M. Greitbauer1 , V. Vécsei1
  • 1University Hospital Vienna, Department of Traumatology, Vienna, Austria
  • 2General Hospital St. Pölten, Department of Traumatology, St. Pölten, Austria
Further Information

Publication History

Publication Date:
15 October 2002 (online)

Abstract

The algorithm of diagnostics and therapy in abdominal trauma patients is discussed using the data from an urban level one trauma centre. In an eight-years period 338 patients with abdominal injuries were admitted. Blunt trauma (n = 193) mainly leads to morphological alterations of the parenchymal organs, predominantly to the spleen. Primary haemodynamic condition as well as additional injuries decide whether primary therapy is operative or non-operative. The most important diagnostic tool seems to be ultrasound, used as a primary screening method. After stabilisation of the patient a contrast CT scan is the golden standard for further diagnosis. In cases of penetrating injuries (n = 145) local surgical revision has to be performed to determine the possible peritoneal penetration. Laparoscopy or primary laparotomy are the subsequent procedures to clarify concomitant intra-abdominal lesions. In cases of therapy resistant haemodynamic instability, emergency Iaparotomy has to be performed. Ultrasound and CT scan have a minor role in these patients protocol. In cases of colonic injury a colostomy is not obligatory, because of the superior result in one-step repair concerning complication rate and infections.

References

  • 1 Abu-Zidan F M, Zayat I, Sheikh M, Mousa I, Behbehani A. Role of ultrasonography in blunt abdominal trauma: a prospective study.  Eur J Surg. 1996;  162 361-365
  • 2 Besselink M G, Berende N C, Preshaw R M, Romano C, Kortbeek J. Non-operative treatment of duodenal perforation secondary to blunt abdominal trauma.  Injury. 2001;  32 513-515
  • 3 Black J J, Sinow R M, Wilson S E, Williams R A. Subcapsular hematoma as a predictor of delayed splenic rupture.  Am Surg. 1992;  58 732-735
  • 4 Demetriades D, Murray J A, Chan L, Ordonez C, Bowley D, Nagy K K, Cornwell E E, Velmahos G C, Munoz N, Hatzitheofilou C, Schwab C W, Rodriguez A, Cornejo C, Davis K A, Namias N, Wisner D H, Ivatury R R, Moore E E, Acosta J A, Maull K I, Thomason M H, Spain D A. Penetrating colon injuries requiring resection: diversion or primary anastomosis? An AAST prospective multicenter study.  J Trauma. 2001;  50 765-775
  • 5 Dente C J, Tyburski J, Wilson R F, Collinge J, Steffes C, Carlin A. Colostomy as a risk factor for posttraumatic infection in penetrating colonic injuries: univariate and multivariate analyses.  J Trauma. 2000;  49 628-634
  • 6 Donohue J H, Federle M P, Griffiths B G, Trunkey D D. Computed tomography in the diagnosis of blunt intestinal and mesenteric injuries.  J Trauma. 1987;  27 11-17
  • 7 Gonzalez R P, Merlotti G J, Holevar M R. Colostomy in penetrating colon injury: is it necessary?.  J Trauma. 1996;  41 271-275
  • 8 Ivatury R R, Porter J M, Simon R J, Islam S, John R, Stahl W M. Intra-abdominal hypertension after life-threatening penetrating abdominal trauma: prophylaxis, incidence, and clinical relevance to gastric mucosal pH and abdominal compartment syndrome.  J Trauma. 1998;  44 1016-1021
  • 9 Kale I T, Kuzu M A, Berkem H, Berkem R, Acar N. The presence of hemorrhagic shock increases the rate of bacterial translocation in blunt abdominal trauma.  J Trauma. 1998;  44 171-174
  • 10 McKenney M G, McKenney K L, Compton R P, Namias N, Fernandez L, Levi D, Arrillaga A, Lynn M, Martin L. Can surgeons evaluate emergency ultrasound scans for blunt abdominal trauma?.  J Trauma. 1998;  44 649-653
  • 11 Nast-Kolb D. Medical, ethical and economical limitations in the treatment of multitrauma patients.  Anaesthesist. 2000;  49 51-57
  • 12 Nast-Kolb D, Waydhas C, Kanz K G, Schweiberer L. An algorithm for management of shock in polytrauma.  Unfallchirurg. 1994;  97 292-302
  • 13 Nelken N, Lewis F. The influence of injury severity on complication rates after primary closure or colostomy for penetrating colon trauma.  Ann Surg. 1989;  209 439-447
  • 14 Pearl W S, Todd K H. Ultrasonography for the initial evaluation of blunt abdominal trauma: A review of prospective trials.  Ann Emerg Med. 1996;  27 353-361
  • 15 Powell R W, Green J B, Ochsner M G, Barttelbort S W, Shackford S R, Sise M J. Peritoneal lavage in pediatric patients sustaining blunt abdominal trauma: a reappraisal.  J Trauma. 1987;  27 6-9
  • 16 Rose J S, Levitt M A, Porter J, Hutson A, Greenholtz J, Nobay F, Hilty W. Does the presence of ultrasound really affect computed tomographic scan use? A prospective randomized trial of ultrasound in trauma.  J Trauma. 2001;  51 545-550
  • 17 Taviloglu K, Gunay K, Ertekin C, Calis A, Turel O. Abdominal stab wounds: the role of selective management.  Eur J Surg. 1998;  164 17-21
  • 18 Timaran C H, Daley B J, Enderson B L. Role of duodenography in the diagnosis of blunt duodenal injuries.  J Trauma. 2001;  51 648-651
  • 19 Tyburski J G, Dente C J, Wilson R F, Shanti C, Steffes C P, Carlin A. Infectious complications following duodenal and/or pancreatic trauma.  Am Surg. 2001;  67 227-230
  • 20 van Haarst E P, van Bezooijen B P, Coene P P, Luitse J S. The efficacy of serial physical examination in penetrating abdominal trauma.  Injury. 1999;  30 599-604
  • 21 VÅcsei V, Grünwald J, Cone J. Versorgungstaktik und -technik nach perforierenden Abdominaltraumen.  Hefte zu „Der Unfallchirurg”. 1994;  239 77-85
  • 22 Zantut L F, Ivatury R R, Smith R S, Kawahara N T, Porter J M, Fry W R, Poggetti R, Birolini D, Organ C H. Diagnostic and therapeutic laparoscopy for penetrating abdominal trauma: a multicenter experience.  J Trauma. 1997;  42 825-829

Christian FialkaM. D 

University Hospital Vienna - Department of Traumatology

Währinger Gürtel 18-20

1090 Vienna

Austria

Phone: + 43-1/4 04 00-59 02

Fax: + 43-1/42 45 07

Email: Christian.Fialka@akh-wien.ac.at

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