Download PDF
Viszeralchirurgie 2001; 36(5): 318-327
DOI: 10.1055/s-2001-17632
ORIGINALARBEIT
© Georg Thieme Verlag Stuttgart · New York

Verletzungen des Intestinums: Diagnostik und Therapie

Intestinal injuries: diagnostics and therapyH.-P. Bruch, R. Bouchard, C. Eckmann, P. Kujath
  • Klinik für Chirurgie, Medizinische Universität Lübeck
Further Information

Publication History

Publication Date:
05 October 2001 (online)

    Permissions and Reprints

Zusammenfassung.

Die Gesamtinzidenz intestinaler Verletzungen beim stumpfen und penetrierenden Abdominaltrauma wird mit 25,2 % angegeben. Die Zeit ist der entscheidende Faktor für den therapeutischen Erfolg bei der Behandlung von Darmverletzungen im Rahmen des stumpfen oder offenen Abdominaltraumas. Eine Verzögerung der Therapie um mehr als 24 Stunden geht mit Mortalitätsraten von bis zu 50 % einher. Derzeit gibt es kein zuverlässiges diagnostisches Verfahren, das intestinale Verletzungen eindeutig nachweist. Gelingt es nicht, eine Dünn- oder Dickdarmverletzung durch die möglichen Untersuchungsverfahren inklusive Laparoskopie aufzudecken oder mit Sicherheit auszuschließen, ist bei persistierender klinischer Symptomatik die Probelaparotomie durchzuführen. In der Diagnostik intestinaler Verletzungen nach stumpfem oder offenem Bauchtrauma müssen alle bildgebenden Verfahren im Vergleich zur klinischen Verlaufseinschätzung kritisch gewertet werden. Anamnese und die körperliche Untersuchung haben nach wie vor den höchsten Stellenwert.

Intestinal injuries: diagnostics and therapy.

The overall incidence of intestinal injuries in blunt or penetrating abdominal trauma is about 25 %. The decisive point in the treatment of these injuries is the time. A delay of more than 24 hours in treatment leads to mortality rates up to 50 %. A safe diagnostic method for the evidence or exclusion of intestinal injury does not exist yet. Uncertain cases call for an explorative laparotomy. Invasive and noninvasive diagnostic procedures have to be taken into account together with clinical data. The history and the result of the clinical examination are still of highest value in the diagnosis of blunt and penetrating abdominal trauma.

Schlüsselwörter:

Stumpfes Bauchtrauma - penetrierendes Bauchtrauma - intestinale Verletzungen - Übersicht.

Key words:

Blunt abdominal trauma - Penetrating abdominal trauma - Intestinal injuries - Review

Literatur

  • 1 Maniatis V, Chryssikopoulos H, Roussakis A. et al . Perforation of the alimentary tract: evaluation with computed tomography.  Abdom Imaging. 2000;  25 373-379
    CrossrefPubMedGoogle Scholar
  • 2 Nagel M, Saeger H D, Massoun H, Buschulte J. [Injuries of the small bowel and colon resulting from abdominal trauma].  Unfallchirurg. 1991;  94 105-109
    PubMedGoogle Scholar
  • 3 Kujath P, Radloff A C. (Hrsg) .Peritonitis.  Bremen-London-Boston; UNI-MED Verlag 2001 36
    Google Scholar
  • 4 Rüter A, Trentz O, Wagner M. (Hrsg) .Unfallchirurgie.  München Wien Baltimore; Urban & Schwarzenberg 1995: 261-351
    Google Scholar
  • 5 Brunner R G, Shatney C H. Diagnostics and therapeutic aspects of rectal trauma. Blunt versus penetrating.  Am Surg. 1987;  53 (4) 215-219
    PubMedGoogle Scholar
  • 6 Nagel M, Kopp H, Hagmüller E, Saeger H D. [Gunshot and stab wounds of the abdomen].  Zentralbl Chir. 1992;  117 453-459
    PubMedGoogle Scholar
  • 7 Degiannis E, Boffard K. Duodenal injuries.  Br J Surg. 2000;  87 1473-1479
    CrossrefPubMedGoogle Scholar
  • 8 McKenzie A D, Bell G A. Nonpenetrating injuries of the colon and rectum.  Surg Clin North Am. 1972;  52 (3) 735-747
    PubMedGoogle Scholar
  • 9 Cogbill T H, Moore E E, Feliciano D V. et al . Conservative management of duodenal trauma: a multicenter perspective.  J Trauma. 1990;  30 (12) 1469-1475
    PubMedGoogle Scholar
  • 10 Shilyansky J, Pearl R H, Kreller M, Sena L M, Babyn P S. Diagnosis and management of duodenal injuries in children.  J Pediatr Surg. 1997;  32 (6) 880-886
    CrossrefPubMedGoogle Scholar
  • 11 Stevens S L, Maull K I. Small bowel injuries.  Surg Clin North Am. 1990;  70 (3) 541-560
    PubMedGoogle Scholar
  • 12 Schumpelick V, Ambacher T, Riesener K P. [Current therapy of injuries of the colon and retroperitoneum].  Chirurg. 1999;  70 1269-1277
    CrossrefPubMedGoogle Scholar
  • 13 Adkins R B, Zirkle P K, Waterhouse G. Penetrating colon trauma.   J Trauma. 1984;  24 (6) 491-499
    PubMedGoogle Scholar
  • 14 Ekkernkamp A, Brand J, Wernet E, Muhr G, Rehn J. [Factors affecting the therapeutic outcome of abdominal trauma. An analysis of 558 Patients].  Unfallchirurg,. 1992;  95 380-386
    PubMedGoogle Scholar
  • 15 Anderson M L, Pasha T M, Leighton J A. Endoscopic perforation of the colon: Lessons from a 10-year-study.  Am J Gastroenterol. 2000;  95 (12) 3418-3422
    CrossrefPubMedGoogle Scholar
  • 16 Melullis M J, Schiedeck T HK, Müller G, Markert U, Bruch H P. Iatrogene Verletzungen des Gastrointestinaltraktes. Indikation zur frühzeitigen laparoskopischen Intervention.  Minimal Invasive Chirurgie,. 1998;  7 (1) 17-20
    PubMedGoogle Scholar
  • 17 El-Banna M, Abdel-Atty M, El-Meteini M, Aly S. Management of laparoscopic-related bowel injuries.  Surg Endosc. 2000;  14 779-782
    CrossrefPubMedGoogle Scholar
  • 18 Smith R S, Fry W R, Morabito D J, Koehler R H, Organ C H. Therapeutic laparoroscopy in trauma.  Am J Surg. 1995;  170 632-637
    CrossrefPubMedGoogle Scholar
  • 19 Gerspach J M, Bellman G C, Stoller M L, Fugelso P. Conservative management of colon injury following percutaneous renal surgery.  Urology. 1997;  49 (6) 831-837
    CrossrefPubMedGoogle Scholar
  • 20 Kropp S, Bleich S, Rudolph B, von Rothkirch M, Ritter E, Birkholz M. Death caused by stomach rupture due to overinflation during oxygen administration via stomach tube.  Arch Kriminol. 1996;  198 (5 - 6) 176-183
    PubMedGoogle Scholar
  • 21 Talmor M, Hoffman L A, Lieberman M. Intestinal perforation after suction lipoplasty: A case report and review of literature.  Ann Plast Surg. 1997;  38 (2) 169-172
    PubMedGoogle Scholar
  • 22 Hornig G W, Shillito J. Intestinal perforation by peritoneal shunt tubing: report of two cases.  Surg Neurol. 1990;  33 288-290
    PubMedGoogle Scholar
  • 23 Schulhof L A, Worth R M, Kalsbeck J E. Bowel perforation due to peritoneal shunt.  Surg Neurol. 1975;  3 265-269
    PubMedGoogle Scholar
  • 24 Kim H C, Han J K, Kim T K. et al . Duodenal perforation as a delayed complication of placement of an esophageal stent.  J Vasc Interv Radiol. 2000;  11 (7) 902-904
    CrossrefPubMedGoogle Scholar
  • 25 Thumbe V K, Houghton A D, Smith M SH. Duodenal perforation by a wallstent.  Endoscopy. 2000;  32 (6) 495-497
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Bianchini A U, Mehta S N, Mulder D S, Barkun A N, Mayrand S. Duodenal perforation by a Greenfield Filter: Endoscopic diagnosis.  Am J Gastroenterol. 1997;  92 (4) 686-687
    PubMedGoogle Scholar
  • 27 Beall A C, Bricker D L, Alessi F J, Whisennand H H, DeBakey M E. Surgical considerations in the management of civilian colon injuries.  Ann Surg. 1971;  173 (6) 971-978
    PubMedGoogle Scholar
  • 28 Flint L M, McCoy M, Richardson J D, Polk H C. Duodenal injury. Analysis of common misconceptions in diagnosis and treatment.  Ann Surg. 1980;  191 (6) 697-702
    PubMedGoogle Scholar
  • 29 Eigler F W, Coone H J. [Injuries of small and large bowel]. Langenbecks Arch Chir Suppl II (Kongreßbericht 1990). 1990: 625-629
    Google Scholar
  • 30 Ballard R B, Badellino M, Eynon C A, Spott M A, Statz C F, Buckman R F. Blunt duodenal rupture: a 6-year statewide experience.  J Trauma. 1997;  43 (2) 229-233
    CrossrefPubMedGoogle Scholar
  • 31 Enderson B L, Maull K I. Missed injuries. The trauma surgeon's nemesis.  Surg Clin North Am. 1991;  71 (2) 399-418
    CrossrefPubMedGoogle Scholar
  • 32 Cobb L M, Vinocur C D, Wagner C W, Weintraub W H. Intestinal perforation due to blunt trauma in children in an era of increased nonoperative treatment.  J Trauma. 1986;  26 (5) 461-463
    PubMedGoogle Scholar
  • 33 Kearny P A, Vahey T, Burney R E, Glazer G. Computed tomography and diagnostic peritoneal lavage in blunt abdominal trauma.  Arch Surg. 1989;  124 344-347
    PubMedGoogle Scholar
  • 34 Bulas D I, Taylor G A, Eichelberger M R. The value of CT in detecting bowel perforation in children after blunt abdominal trauma.  Am J Roentgenol. 1989;  153 561-564
    PubMedGoogle Scholar
  • 35 Ciftci A O, Tanyel F C, Salman A B, Büyükpamukcu N, Hicsönmez A. Gastrointestinal tract perforation due to blunt abdominal trauma.  Pediatr Surg Int. 1998;  13 259-264
    CrossrefPubMedGoogle Scholar
  • 36 Hammann J, Spohn K. Peritonitis nach stumpfen Verletzungen des Bauches.  Chirurg. 1971;  42 (10) 437-444
    PubMedGoogle Scholar
  • 37 Malhorta A K, Fabian T C, Katsis S B, Gavant M L, Croce M A. Blunt bowel and mesenteric injuries: The role of screening computed tomography.  J Trauma. 2000;  48 (6) 991-1000
    PubMedGoogle Scholar
  • 38 Shankar K R, Lloyd D A, Kitteringham L, Carty H ML. Oral contrast with computed tomography in the evaluation of blunt abdominal trauma in children.  Br J Surg. 1999;  86 (8) 1073-1077
    CrossrefPubMedGoogle Scholar
  • 39 Bittner R, Roscher R. [Gastric, duodenal and pancreatic trauma: Diagnostics and operative procedures]. Langenbecks Arch Chir Suppl II (Kongreßbericht 1990). 1990: 617-623
    Google Scholar
  • 40 Dapunt O, Karlbauer A, Möseneder H, Boeckl O. Verletzung des Magen-Darm-Traktes nach stumpfem Bauchtrauma.  Chirurg. 1985;  56 (11) 695-698
    PubMedGoogle Scholar
  • 41 Fabian T C, Croce M A, Stewart R M, Pritchard F E, Minard G, Kudsk K A. A prospective analysis of diagnostic laparoscopy in trauma.  Ann Surg. 1993;  217 (5) 557-565
    PubMedGoogle Scholar
  • 42 Asensio J A, Berne J, Demetriades D, Murray J, Gomez H, Falabella A. et al . Penetrating esophageal injuries: Time interval of safety for preoperative evaluation - how long is safe?.  J Trauma. 1997;  43 (2) 319-324
    PubMedGoogle Scholar
  • 43 Asensio J A, Chahwan S, Forno W, MacKersie R, Wall M, Lake J. et al . Penetrating esophageal injuries: Multicenter study of the American Association for the Surgery of Trauma.  J Trauma. 2001;  50 289-296
    PubMedGoogle Scholar
  • 44 Feliciano D V, Burch J M, Spjut-Patrinely V, Mattox K L, Jordan G L. Abdominal gunshot wounds. An urban trauma center's experience with 300 consecutive patients.  Ann Surg. 1988;  208 (3) 362-370
    CrossrefPubMedGoogle Scholar
  • 45 Demetriades D, Charalambides D, Lakhoo M, Pantanowitz D. Gunshot wounds of the abdomen: role of selective conservative management.  Br J Surg. 1991;  78 220-222
    PubMedGoogle Scholar
  • 46 Woolcott R. The safety of laparoscopy performed by direct trocar insertion and carbon dioxide insufflation under vision.  Aust N Z J Obstet Gynaecol. 1997;  37 (2) 216-219
    PubMedGoogle Scholar
  • 47 Riedl S, Buhr H J, Herfarth C h. [Effect of diagnostic imaging techniques on choice of therapy and prognosis of traumatic pancreas and duodenal injuries].  Langenbecks Arch Chir. 1994;  379 (1) 38-43
    PubMedGoogle Scholar
  • 48 Weigelt J A. Duodenal injuries.  Surg Clin North Am. 1990;  70 (3) 529-539
    PubMedGoogle Scholar
  • 49 Robbs J V, Moore S W. Pillay SP. Blunt abdominal trauma with jejunal injury: a review.  J Trauma. 1980;  20 (4) 308-311
    PubMedGoogle Scholar
  • 50 Moore E E, CogbillTH, Malangoni M A, Jurkovich G J, Champion I, Gennarelli T A. Organ injury scaling II: Pancreas, duodenum, small bowel, colon and rectum.  J Trauma,. 1990;  30 (11) 1427-1429
    CrossrefPubMedGoogle Scholar
  • 51 Waldner H, Erhard J, Hallfeldt K, Schweiberer L. [Emergency laparoscopy for abdominal stab wounds].  Chirurg. 1995;  66 1105-1109
    PubMedGoogle Scholar
  • 52 Schmidt U, Maull K, Gould H, Frame S. [The role of computed tomography in blunt hollow visceral injury].  Unfallchirurg. 1994;  97 54-56
    PubMedGoogle Scholar
  • 53 Bünte H, Filler D. Das traumatisch bedingte Abdomen.  Münch Med Wochenschr. 1974;  116 (27) 1301-1308
    PubMedGoogle Scholar
  • 54 Sherck J P, Oakes D O. Intestinal injuries missed by computed tomography.  J Trauma. 1990;  30 (1) 1-7
    PubMedGoogle Scholar
  • 55 Kirschner P, Brünner H. Die Verletzung des Dünndarms im Rahmen stumpfer abdomineller Kombinationstraumen.  Therapiewoche. 1974;  39 4268-4273
    PubMedGoogle Scholar
  • 56 Yoshii H, Sato M, Yamamoto S, Motegi M, Okusawa S, Kitano M. et al . Usefulness and limitations of ultrasonography in the initial evaluation of blunt abdominal trauma.  J Trauma. 1998;  45 (1) 45-50
    PubMedGoogle Scholar
  • 57 Ivatury R R, Nassoura Z E, Simon R J, Rodriguez A. Complex duodenal injuries.  Surg Clin North Am. 1996;  76 (4) 797-812
    CrossrefPubMedGoogle Scholar
  • 58 Snyder W H, Weigelt J A, Watkins W L, Bietz D S. The surgical management of duodenal trauma.  Arch Surg. 1980;  115 422-429
    PubMedGoogle Scholar
  • 59 Waydhas C, Nast-Kolb D, Blahs U, Pfeifer K J, Schweiberer L. Abdominelle Sonographie versus Peritoneallavage in der Schockraumdiagnostik beim Polytrauma.  Chirurg. 1991;  62 (11) 789-793
    PubMedGoogle Scholar
  • 60 Hoffmann R, Nerlich M, Muggia-Sullam M, Pohlemann T, Wippermann B, Regel G. et al . Blunt abdominal trauma in cases of multiple trauma evaluated by ultrasonography: a prospective analysis of 291 patients.  J Trauma. 1992;  32 (4) 452-458
    CrossrefPubMedGoogle Scholar
  • 61 McKenny M, Lentz K, Nunez D, Sosa J L, Sleeman D, Axelrad A. et al . Can ultrasound replace diagnostic peritoneal lavage in the assessment of blunt abdominal trauma?.  J Trauma. 1994;  37 (3) 439-441
    PubMedGoogle Scholar
  • 62 Bode P J, Niezen R A, van Vugt A B, Schipper J. Abdominal ultrasound as a reliable indicator for conclusive laparotomy in blunt abdominal trauma.  J Trauma. 1993;  34 (1) 27-31
    PubMedGoogle Scholar
  • 63 McKenny M, Martin L, Lentz K, Lopez C, Sleeman D, Aristide G. et al . 1000 consecutive ultrasounds for blunt abdominal trauma.   J Trauma. 1996;  40 (4) 607-612
    PubMedGoogle Scholar
  • 64 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 (1) 11-17
    PubMedGoogle Scholar
  • 65 Kunin J R, Korobkin M, Ellis J H, Francis I R, Kane N M, Siegel S E. Duodenal injuries caused by blunt abdominal trauma. Value of CT in differentiating perforation from hematoma.  Am J Roentgenol. 1993;  160 1221-1223
    PubMedGoogle Scholar
  • 66 Mirvis S E, Gens D R, Shanmuganathan K. Rupture of the bowel after blunt abdominal trauma: Diagnosis with CT.  Am J Roentgenol. 1992;  159 1217-1221
    PubMedGoogle Scholar
  • 67 Nemcek A A. CT of acute gastrointestinal disorders.  Radiol Clin North Am. 1989;  27 (4) 773-786
    PubMedGoogle Scholar
  • 68 Liu M, Lee C H, P'eng F K. Prospective comparison of diagnostic peritoneal lavage, computed tomographic scanning and ultrasonography for the diagnosis of blunt abdominal trauma.   J Trauma. 1993;  35 (2) 267-270
    PubMedGoogle Scholar
  • 69 Barras J P, Gilg M, Regli B, Schweizer W. Sekundäre Peritonitis nach negativem Computertomogramm beim stumpfen Abdominaltrauma.  Helv Chir Acta. 1993;  60 513-516
    PubMedGoogle Scholar
  • 70 Meredith J W, Ditesheim J A, Stonehouse S, Wolfman N. Computed tomography and diagnostic peritoneal lavage. Complementary roles in blunt trauma.  Ann Surg. 1992;  58 44-48
    PubMedGoogle Scholar
  • 71 Becker C D, Mentha G, Schmidlin F, Terrier F. Blunt abdominal trauma in adults: role of CT in the diagnosis and management of visceral injuries.  Eur Radiol. 1998;  8 772-780
    CrossrefPubMedGoogle Scholar
  • 72 Sherck J, Shatney C, Sensaki K, Selivanov V. The accuracy of computed tomography in the diagnosis of blunt small-bowel perforation.  Am J Surg. 1994;  168 670-675
    CrossrefPubMedGoogle Scholar
  • 73 Hawkins M L, Scofield W M, Carraway R P, Laws H L. Diagnostic peritoneal lavage in blunt trauma.  South Med J. 1988;  81 (3) 293-296
    PubMedGoogle Scholar
  • 74 Steenblock U, Claudi B, Dittmann M, Wolff G. Peritoneallavage beim stumpfen Bauchtrauma. Diagnostik und Verlaufsbeobachtung beim Mehrfachverletzten.  Helv Chir Acta. 1977;  44 87-88
    PubMedGoogle Scholar
  • 75 Fischer R P, Beverlin B C, Engrav L H, Benjamin C, Perry J F. Diagnostic peritoneal lavage. Fourteen years and 2586 patients later.  Am J Surg. 1978;  136 701-704
    CrossrefPubMedGoogle Scholar
  • 76 Root H D, Hauser C W, McKinley C R, LaFave J W, Mendiola R P. Diagnostic peritoneal lavage.  Surgery. 1965;  57 (5) 633-637
    PubMedGoogle Scholar
  • 77 Soyka J M, Martin M, Sloan E P, Himmelman R G, Batesky D, Barrett J A. Diagnostic peritoneal lavage: Is an isolated WBC count > 500/ mm3 predictive of intra-abdominal injury requiring celiotomy in blunt trauma patients?.  J Trauma. 1990;  30 (7) 874-879
    PubMedGoogle Scholar
  • 78 Guarino J, Hassett J M, Luchette F A. Small bowel injuries. Mechanisms, patterns and outcome.  J Trauma. 1995;  39 (6) 1076-1080
    PubMedGoogle Scholar
  • 79 Feussner H, Papaziogas W, Siewert J R. [Modern diagnostic workup of blunt abdominal trauma].  Chirurg. 1999;  70 1246-1254
    CrossrefPubMedGoogle Scholar
  • 80 Schreiber M A, Gentinello L M, Rhee P, Jurkovich G J, Maier R V. Limiting computed tomography to patients with peritoneal lavage-positive results reduces cost and unnecessary celiotomies in blunt trauma.  Arch Surg. 1996;  131 954-959
    PubMedGoogle Scholar
  • 81 Rückert K, Starker M, Schreyer T, Kümmerle F. Ultraschall und Peritoneallavage in der Dianostik des stumpfen Bauchtraumas.  Hefte zur Unfallheilkunde. 1984;  163 80
    PubMedGoogle Scholar
  • 82 Alyono D, Perry J F. Significance of repeating diagnostic peritoneal lavage.  Surgery. 1982;  91 (6) 656-659
    PubMedGoogle Scholar
  • 83 McAnena O J, Marx J A, Moore E E. Peritoneal lavage enzyme determinations following blunt and abdominal trauma.  J Trauma. 1991;  31 (8) 1161-1164
    PubMedGoogle Scholar
  • 84 Rossi P, Mullins D, Thal E. Role of laparoscopy in the evaluation of abdominal trauma.  Am J Surg. 1993;  166 707-711
    PubMedGoogle Scholar
  • 85 Ammann J, Engelhardt G, Blessing H. Die Stellung der Laparoskopie beim stumpfen Bauchtrauma.  Helv Chir Acta,. 1977;  44 89-91
    PubMedGoogle Scholar
  • 86 Grassi R, Pinto A, Rossi G, Rotondo A. Conventional plain-film radiology, ultrasonography and CT in jejuno-ileal perforation.  Acta Radiol. 1998;  39 52-56
    PubMedGoogle Scholar
  • 87 Leppäniemi A K, Voutilainen P, Haapiainen R K. Indications for early mandatory laparotomy in abdominal stab wounds.  Br J Surg. 1999;  86 76-80
    CrossrefPubMedGoogle Scholar
  • 88 Fry R D. Anorectal trauma and foreign bodies.  Surg Clin North Am. 1994;  74 (6) 1491-1505
    PubMedGoogle Scholar
  • 89 Grasberger R C, Hirsch E F. Rectal trauma. A retrospective analysis and guidelines for therapy.  Am J Surg. 1983;  145 795-799
    CrossrefPubMedGoogle Scholar
  • 90 Nast-Kolb D, Waydhas C, Kastl S, Duswald K H, Schweiberer L. Stellenwert der Abdominalverletzung für den Verlauf des Polytraumatisierten.  Chirurg. 1993;  64 (7) 552-559
    PubMedGoogle Scholar
  • 91 Nast-Kolb D, Trupka A, Ruchholtz S, Schweiberer L. Abdominaltrauma.  Unfallchirurg. 1998;  101 (2) 82-91
    CrossrefPubMedGoogle Scholar
  • 92 Ertel W, Trentz O. Das stumpfe und penetrierende Abdominaltrauma.  Unfallchirurg. 1996;  99 288-303
    PubMedGoogle Scholar
  • 93 Ivatury R R, Simon R J, Weksler B, Bayard V, Stahl W M. Laparoscopy in the evaluation of the intrathoracic abdomen after penetrating injury.  J Trauma. 1992;  33 (1) 101-109
    PubMedGoogle Scholar
  • 94 Ivatury R R, Simon R R, Stahl W M. A critical evaluation of laparoscopy in penetrating abdominal trauma.  J Trauma. 1993;  34 (6) 822-828
    PubMedGoogle Scholar
  • 95 Ortega A E, Tang E, Froes T, Asensio J A, Katkhouda N, Demtriades D. Laparoscopic evaluation of penetrating thoracoabdominal traumatic injuries.  Surg Endosc. 1996;  10 19-22
    CrossrefPubMedGoogle Scholar
  • 96 Demetriades D, Rabinowitz B. Indications for operation in abdominal stab wounds. A prospektive study of 651 patients.  Ann Surg. 1987;  205 (2) 129-132
    PubMedGoogle Scholar
  • 97 Goldberger J H, Bernstein D M, Rodman G H, Suarez C A. Selection of patients with abdominal stab wounds for laparotomy.  J Trauma. 1982;  22 (6) 476-480
    PubMedGoogle Scholar
  • 98 Hallfeldt K KJ, Trupka A W, Erhard J, Waldner H, Schweiberer L. Emergency laparoscopy for abdominal stab wounds.  Surg Endosc. 1998;  12 907-910
    CrossrefPubMedGoogle Scholar
  • 99 Ertekin C, Yamaner S, Güloglu R, Günay K, Belgerden S. [The role of diagnostic laparoscopy in the treatment of penetrating injuries of the lower thoracic wall and anterior abdominal wall].  Zentralbl Chir. 1997;  122 (7) 535-537
    PubMedGoogle Scholar
  • 100 Leppäniemi A, Salo J, Haapiainen R. Complications of negative laparotomy for truncal stab wounds.  J Trauma. 1995;  38 (1) 54-58
    CrossrefPubMedGoogle Scholar
  • 101 McIntyre R, Auld C D, Cuschieri R J, Taggart I, McKay A J. Penetrating abdominal stab wounds: a plea for a more conservative policy.  Injury. 1989;  20 355-358
    CrossrefPubMedGoogle Scholar
  • 102 Nagel M, Ockert D, Saeger H D. [Management of abdominal stab wounds].  Unfallchirurg. 1994;  97 419-423
    PubMedGoogle Scholar
  • 103 Namias N, Kopelman T, Sosa J L. Laparoscopic colostomy for a gunshot wound to the rectum.  J Laparoendosc Surg. 1995;  5 (4) 251-253
    PubMedGoogle Scholar
  • 104 Sosa J L, Baker M, Puente I, Sims D, Sleeman D, Ginzburg E. et al . Negative laparotomy in abdominal gunshot wounds: Potential impact of laparoscopy.  J Trauma. 1995;  38 (2) 194-197
    PubMedGoogle Scholar

Prof. Dr. H.-P. Bruch

Klinik für Chirurgie
Medizinische Universität

Ratzeburger Allee 160

23538 Lübeck