PENETRATING ABDOMINAL-TRAUMA - THE CHALLENGE

High-velocity missiles fired from weapons of war cause severe injuries because of the intense energy that they transfer on impact with the l iving targets. The most important factors in the reduction of morbidit y and mortality are first aid, rapid evacuation of victims and early p rimary surgery. Infection of wounds can arise from skin organisms and from enteric aerobes and anaerobes. Wounds involving the colon present particular problems due to bacterial contamination and the insecurity of suturing which can result in leakage. Although prompt surgery is a prerequisite for the successful treatment of patients with high-veloc ity abdominal wounds, early administration of appropriate antibiotics reduces morbidity and mortality since many post-surgical deaths are re lated to septic complications. Penetrating abdominal wounds encountere d in most hospital emergency departments are usually caused by knives and low-velocity pistol bullets. However, in the prevention of infecti on, no standard optimal antibiotic regimen or length of treatment has been established. Combination regimens with aminoglycoside antibiotics have been widely used, but single beta-lactam regimens are an attract ive alternative because of their wide anti-microbial spectrum and cost effectiveness. Short-term antibiotic regimens are as efficacious as l ong-term treatment, but certain risk factors must be considered.