Penetrierende abdominelle Verletzungen

Die Inzidenz penetrierender Abdominaltraumata nimmt nicht nur im urbanen Umfeld zu, sondern gewinnt durch die Präsenz von Kriegsverletzten in Mitteleuropa zunehmend an Relevanz. In diesem Artikel sollen grundlegende diagnostische und therapeutische Prinzipien in Abhängigkeit vom Verletzungsausmaß und der hämodynamischen Stabilität Betroffener beleuchtet werden.

Schlüsselwörter

Kriegsverletzung - penetrierendes Trauma - Abdominaltrauma - Damage Control Surgery - selektives nicht operatives Management

Keywords

war injury - penetrating trauma - abdominal trauma - damage control surgery - selective nonoperative management

• Literatur

• 1 Turégano-Fuentes F, Pérez-Diaz D, Sanz-Sánchez M. et al. Abdominal blast injuries: Different patterns, severity, management, and prognosis according to the main mechanism of injury. Eur J Trauma Emerg Surg 2014; 40: 451-460
• 2 Bieler D, Kollig E, Hackenberg L. et al. Penetrating injuries in Germany – epidemiology, management and outcome an analysis based on the TraumaRegister DGU®. Scand J Trauma Resusc Emerg Med 2021; 29: 80
• 3 Maleitzke T, Zhou S, Zocholl D. et al. Routine laboratory parameters predict intensive care unit admission and hospitalization in patients suffering stab injuries. Front Immunol 2023; 13: 959141
• 4 Bundesministerium für Gesundheit. Medizinische Versorgung der Menschen aus der Ukraine. Accessed January 04, 2024 at: https://www.bundesgesundheitsministerium.de/medizinische-versorgung-der-menschen-aus-ukraine
• 5 Berger FK, Schmartz GP, Fritz T. et al. Occurrence, resistance patterns, and management of carbapenemase-producing bacteria in war-wounded refugees from Ukraine. Int J Infect Dis 2023; 132: 89-92
• 6 Coupland R. Abdominal wounds in war. Br J Surg 1996; 83: 1505-1511
• 7 Rautio J, Paavolainen P. Afghan war wounded: Experience with 200 cases. J Trauma 1988; 28: 523-525
• 8 Güsgen C, Willms A, Richardsen I. et al. Besonderheiten und Versorgung penetrierender Verletzungen am Beispiel von Schuss- und Explosionsopfern ohne ballistischen Körperschutz in Afghanistan (2009–2013). Zentralbl Chir 2017; 142: 386-394
• 9 Behbehani A, Abu-Zidan F, Hasaniya N. et al. War injuries during the Gulf War: Experience of a teaching hospital in Kuwait. Ann R Coll Surg Engl 1994; 76: 407-411
• 10 Cardi M, Ibrahim K, Alizai SW. et al. Injury patterns and causes of death in 953 patients with penetrating abdominal war wounds in a civilian independent non-governmental organization hospital in Lashkargah, Afghanistan. World J Emerg Surg 2019; 14: 51
• 11 Alsaid B, Alhimyar M, Alnweilaty A. et al. Laparotomy Due to War-Related Penetrating Abdominal Trauma in Civilians: Experience from Syria 2011–2017. Disaster Med Public Health Prep 2021; 15: 615-623
• 12 Gumeniuk K, Lurin IA, Tsema I. et al. Gunshot injury to the colon by expanding bullets in combat patients wounded in hybrid period of the Russian-Ukrainian war during 2014–2020. BMC Surg 2023; 23: 23
• 13 Morris DS, Sugrue WJ. Abdominal injuries in the war wounded of Afghanistan: A report from the International Committee of the Red Cross Hospital in Kabul. Br J Surg 1991; 78: 1301-1304
• 14 Deutsche Gesellschaft für Unfallchirurgie e.V., Deutsche Gesellschaft für Orthopädie und Unfallchirurgie e.V.. Polytrauma/Schwerverletzten-Behandlung – S3-Leitlinie. 2022 Accessed April 30, 2024 at: https://register.awmf.org/assets/guidelines/187–023l_S3_Polytrauma-Schwerverletzten-Behandlung_2023–06.pdf
• 15 Savoia P, Jayanthi S, Chammas M. Focused assessment with sonography for trauma (FAST). J Med Ultrasound 2023; 31: 101-106
• 16 Rozycki GS, Ballard RB, Feliciano DV. et al. Surgeon-performed ultrasound for the assessment of truncal injuries: Lessons learned from 1540 patients. Ann Surg 1998; 228: 557-567
• 17 Melniker LA, Leibner E, McKenney MG. et al. Randomized Controlled Clinical Trial of Point-of-Care, Limited Ultrasonography for Trauma in the Emergency Department: The First Sonography Outcomes Assessment Program Trial. Ann Emerg Med 2006; 48: 227-235
• 18 Quinn AC, Sinert R. What is the utility of the Focused Assessment with Sonography in Trauma (FAST) exam in penetrating torso trauma?. Injury 2011; 42: 482-487
• 19 Beekley AC, Blackbourne LH, Sebesta JA. et al. Selective nonoperative management of penetrating torso injury from combat fragmentation wounds. J Trauma 2008; 64 (2 Suppl.): S108-S116
• 20 Kumar S, Kumar A, Joshi K. et al. Comparison of diagnostic peritoneal lavage and focused assessment by sonography in trauma as an adjunct to primary survey in torso trauma: a prospective randomized clinical trial. Ulus Travma Acil Cerrahi Derg 2014; 20: 101-106
• 21 Rowell SE, Barbosa RR, Holcomb JB. et al. The focused assessment with sonography in trauma (FAST) in hypotensive injured patients frequently fails to identify the need for laparotomy: A multi-institutional pragmatic study. Trauma Surg Acute Care Open 2019; 4: e000207
• 22 Malkomes P, Störmann P, El Youzouri H. et al. Characteristics and management of penetrating abdominal injuries in a German level I trauma center. Eur J Trauma Emerg Surg 2019; 45: 315-321
• 23 Shanmuganathan K, Mirvis SE, Chiu WC. et al. Penetrating torso trauma: Triple-contrast helical CT in peritoneal violation and organ injury -- a prospective study in 200 patients. Radiology 2004; 231: 775-784
• 24 Morrison JJ, Clasper JC, Gibb I. et al. Management of penetrating abdominal trauma in the conflict environment: The role of computed tomography scanning. World J Surg 2011; 35: 27-33
• 25 Uranues S, Popa DE, Diaconescu B. et al. Laparoscopy in penetrating abdominal trauma. World J Surg 2015; 39: 1381-1388
• 26 Cocco AM, Bhagvan S, Bouffler C. et al. Diagnostic laparoscopy in penetrating abdominal trauma. ANZ J Surg 2019; 89: 353-356
• 27 Mitchell TA, Hutchison T, Becker TE. et al. Nontherapeutic laparotomy in American combat casualties: A 10-year review. J Trauma Acute Care Surg 2014; 77 (2 Suppl.): S171-S175
• 28 Farraj M, Bramnick Z, Kruchin B. et al. Expectant management in delayed presentation of war casualties with penetrating abdominal trauma. Injury 2022; 53: 160-165
• 29 Leppäniemi AK. Abdominal war wounds -- experiences from Red Cross field hospitals. World J Surg 2005; 29 (Suppl. 1) S67-S71
• 30 Renz BM, Feliciano DV. Unnecessary laparotomies for trauma: A prospective study of morbidity. J Trauma 1995; 38: 350-356
• 31 Bozzay JD, Walker PF, Schechtman DW. et al. Risk factors for abdominal surgical site infection after exploratory laparotomy among combat casualties. J Trauma 2021; 91 (2S Suppl. 2): S247-S255
• 32 Saghafinia M, Nafissi N, Motamedi MR. et al. Assessment and outcome of 496 penetrating gastrointestinal warfare injuries. J R Army Med Corps 2010; 156: 25-27
• 33 Arafat S, Alsabek MB, Ahmad M. et al. Penetrating abdominal injuries during the Syrian war: Patterns and factors affecting mortality rates. Injury 2017; 48: 1054-1057
• 34 Lynch T, Kilgar J, Al Shibli A. Pediatric Abdominal Trauma. Curr Pediatr Rev 2018; 14: 59-63
• 35 Demetriades D, Velmahos G, Cornwell E. et al. Selective nonoperative management of gunshot wounds of the anterior abdomen. Arch Surg 1997; 132: 178-183
• 36 Salim A, Velmahos GC. When to operate on abdominal gunshot wounds. Scand J Surg 2002; 91: 62-66
• 37 Leppäniemi A. Nonoperative management of solid abdominal organ injuries: From past to present. Scand J Surg 2019; 108: 95-100
• 38 Cimbanassi S, Chiara O, Leppaniemi A. et al. Nonoperative management of abdominal solid-organ injuries following blunt trauma in adults: Results from an International Consensus Conference. J Trauma Acute Care Surg 2018; 84: 517-531
• 39 Hirsberg A, Mattox KL. ‘Damage control’ in trauma surgery. Br J Surg 1993; 80: 1501-1502