ABDOMINAL-TRAUMA

While a great part of the Anglo-American medical literature addresses the topic of penetrating trauma the German spreaking countries rather publish on blunt abdominal injury. The presented paper discusses the s trategic principles of acute clinical management of abdominal trauma o n the combined basis of own research results and a comprehensive revie w of the literature. Blunt abdominal injuries in most cases from a par t in the pattern of multiple trauma. The early, first-hours mortality is most often caused by severe traumatic brain injury or abdominal tra uma with massive hemorrhage. The prehospital management of penetrating injuries is characterized rather by the concept of 'load and go', whe reas the on-scene stabilization of the patient with blunt abdominal in jury should precede transport to the adequate hospital. On arrival in the accident and emergency room an immediate blood transfusion is reco mmended far hemodynamically unstable patients. If then a stabilization is not achieved, an emergency laparotomy should follow. Abdominal sta b injuries should be explored by laparoscopy if an intraperitoneal les ion is suspected. If then the possibility of an intestinal lesion is p resent a laparotomy should be performed directly thereafter. Firearm i njuries require open revision in almost all cases. The standard diagno stic technique in blunt abdominal trauma is sonography, assisted by co mputed tomography and, if indicated, angiography in hemodynamically st able patients. Isolated abdominal injuries without hemodynamic or coag ulation disorders allow conservative treatment in the intensive care s etting. In severe multiple trauma as well as in manifest shock even th e smallest fluid detection should lead to laparotomy. The surgical tre atment of splenic rupture is still a matter of discussion. Splenectomy is indicated in patients with severe concomitating injuries or shock whereas in the remainder of cases the total or partial preservation of the spleen should be pursued. Hepatic injuries offer a broad spectrum of operative interventions, ranging from superficial hemostatic measu res over compression techniques like 'packing' and 'mesh-wrapping' to atypical and anatomical resections and to liver transplantation in exc eptional cases. Lesions of tubular organs and the pancreas pose especi ally difficult diagnostical problems but regularly allow a rather easy operative treatment.