Primary Treatment of Abdominal Trauma

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.

Key words

Abdominal trauma - Colonic injury - Penetrating injury - Therapy algorithm

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