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.

Abdominal trauma - Colonic injury - Penetrating injury - Therapy algorithm

References

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