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
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Prof. Dr. H.-P. Bruch
Klinik für Chirurgie
Medizinische Universität
Ratzeburger Allee 160
23538 Lübeck
