Abdominaltrauma in der Intensivmedizin

Abdominaltraumata werden in stumpfe und penetrierende Verletzungen unterteilt, wobei Letztere durch die traumatische Eröffnung des Peritoneal- und/oder Retroperitonealraums gekennzeichnet sind. Stumpfe Abdominalverletzungen treten überwiegend im Rahmen eines Polytraumas auf [1]. Das Abdominaltrauma zeichnet sich durch eine hohe Letalität aus. Maßgebend für die Prognose sind die präzise Diagnostik und Therapie sowie präklinische Versorgungsmaßnahmen am Unfallort wie auch das nachfolgende innerklinische Management [2].

Schlüsselwörter

FAST-Sonografie - Damage Control Surgery - Milzruptur - Leberruptur - Schockraum - Bauchtrauma - Polytrauma

• Literatur

• 1 Coccolini F, Montori G, Catena F. et al. Splenic trauma: WSES classification and guidelines for adult and pediatric patients. World J Emerg Surg 2017; 12: 40
• 2 Jahresbericht 2021 – TraumaRegister DGU für das Unfalljahr 2020. Höfer C, Lefering R. Accessed January 26, 2023 at: https://www.traumaregister-dgu.de/fileadmin/user_upload/TR-DGU_Jahresbericht_2021.pdf
• 3 Deutsche Gesellschaft für Unfallchirurgie e. V. (DGU) (federführend). et al. S3-Leitlinie Polytrauma/Schwerverletzten-Behandlung – neue Register-Nr.: 187–023, Stand 2016 (gültig bis 30.06.2021). Accessed January 30, 2023 at: https://register.awmf.org/de/leitlinien/detail/012–019
• 4 Miller MT, Pasquale MD, Bromberg WJ. et al. Not so FAST. J Trauma 2003; 54: 52-59
• 5 Sliwinski S, Bechstein WO, Schnitzbauer AA. et al. Das penetrierende Abdominaltrauma. Der Chir 2020; 91: 979-988
• 6 Becker CD, Mentha G, Terrier F. Blunt abdominal trauma in adults: role of CT in the diagnosis and management of visceral injuries. Part 1: liver and spleen. Eur Radiol 1998; 8: 553-562
• 7 Liu M, Lee CH, P’eng FK. Prospective comparison of diagnostic peritoneal lavage, computed tomographic scanning, and ultrasonography for the diagnosis of blunt abdominal trauma. J Trauma 1993; 35: 267-270
• 8 Brenner M, Hicks C. Major abdominal trauma: critical decisions and new frontiers in management. Emerg Med Clin North Am 2018; 36: 149-160
• 9 PearceSalotti JA, Little MP. et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet (London, England) 2012; 380: 499-505
• 10 Shanmuganathan K, Mirvis SE, Sover ER. Value of contrast-enhanced CT in detecting active hemorrhage in patients with blunt abdominal or pelvic trauma. AJR Am J Roentgenol 1993; 161: 65-69
• 11 Waibel BH, Rotondo MF. Damage control in trauma and abdominal sepsis. Crit Care Med 2010; 38: S421-S430
• 12 Offner PJ, de Souza AL, Moore EE. et al. Avoidance of abdominal compartment syndrome in damage-control laparotomy after trauma. Arch Surg 2001; 136: 676-681
• 13 Abikhaled JA, Granchi TS, Wall MJ. et al. Prolonged abdominal packing for trauma is associated with increased morbidity and mortality. Am Surg 1997; 63: 1103-1109
• 14 Hunt L, Frost SA, Hillman K. et al. Management of intra-abdominal hypertension and abdominal compartment syndrome: a review. J Trauma Manag Outcomes 2014; 8: 2
• 15 Beekley AC. Damage control resuscitation: a sensible approach to the exsanguinating surgical patient. Crit Care Med 2008; 36: S267-S274
• 16 Burggraf M, Payas A, Kauther MD. et al. Evaluation of clotting factor activities early after severe multiple trauma and their correlation with coagulation tests and clinical data. World J Emerg Surg 2015; 10: 43
• 17 Brohi K, Cohen MJ, Ganter MT. et al. Acute traumatic coagulopathy: initiated by hypoperfusion: modulated through the protein C pathway?. Ann Surg 2007; 245: 812-818
• 18 Schöchl H, Frietsch T, Pavelka M. et al. Hyperfibrinolysis after major trauma: differential diagnosis of lysis patterns and prognostic value of thrombelastometry. J Trauma 2009; 67: 125-131
• 19 Vargas M, García A, Caicedo Y. et al. Damage control in the intensive care unit: what should the intensive care physician know and do?. Colomb Med 2021; 52: e4174810
• 20 Hess JR, Brohi K, Dutton RP. et al. The coagulopathy of trauma: a review of mechanisms. J Trauma 2008; 65: 748-754
• 21 Hardy JF. Current status of transfusion triggers for red blood cell concentrates. Transfus Apher Sci 2004; 31: 55-66
• 22 Carson JL, Stanworth SJ, Dennis JA. et al. Transfusion thresholds for guiding red blood cell transfusion. Cochrane Database Syst Rev 2021;
• 23 [Anonym]. Querschnitts-Leitlinien (BÄK) zur Therapie mit Blutkomponenten und Plasmaderivaten. 4. überarbeitete und aktualisierte Auflage 2014. Accessed January 26, 2023 at: https://www.bundesaerztekammer.de/fileadmin/user_upload/_old-files/downloads/QLL_Haemotherapie_2014.pdf
• 24 Roberts I, Shakur H, Coats T. et al. The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health Technol Assess 2013; 17: 1-79
• 25 Khan S, Allard S, Weaver A. et al. A major haemorrhage protocol improves the delivery of blood component therapy and reduces waste in trauma massive transfusion. Injury 2013; 44: 587-592
• 26 Yücel N, Lefering R, Maegele M. et al. Trauma Associated Severe Hemorrhage (TASH)-Score: probability of mass transfusion as surrogate for life threatening hemorrhage after multiple trauma. J Trauma 2006; 60: 1227-1228
• 27 Hommes M, Navsaria PH, Schipper IB. et al. Management of blunt liver trauma in 134 severely injured patients. Injury 2015; 46: 837-842
• 28 Moore EE, Cogbill TH, Malangoni MA. et al. Organ injury scaling, II: Pancreas, duodenum, small bowel, colon, and rectum. J Trauma 1990; 30: 1427-1429
• 29 Badger SA, Barclay R, Campbell P. et al. Management of liver trauma. World J Surg 2009; 33: 2522-2537
• 30 Coccolini F, Coimbra R, Ordonez C. et al. Liver trauma: WSES 2020 guidelines. World J Emerg Surg 2020; 15: 24
• 31 Shrestha B, Holcomb JB, Camp EA. et al. Damage-control resuscitation increases successful nonoperative management rates and survival after severe blunt liver injury. J Trauma Acute Care Surg 2015; 78: 336-341
• 32 Schwab R, Germer CT, Lang H. Notfälle in der Allgemein- und Viszeralchirurgie: Kurze Wege zur Therapieentscheidung. Berlin, Heidelberg: Springer; 2019
• 33 Hecker A, Hecker M, Riedel JG. et al. Neue WSES-AAST-Leitlinie zum Trauma des Duodenums, des Pankreas und der extrahepatischen Gallengänge – Zusammenfassung und Kommentar. Chirurg 2020; 91: 681-684
• 34 Clausen J-D, Winkelmann M, Mommsen P. Modernes Traumamanagement BT - Orthopädie und Unfallchirurgie. Berlin, Heidelberg: Springer Berlin Heidelberg; 2019: 1-11