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Spezielle chirurgische Prinzipien in der Behandlung des traumatischen Abdomens

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Praxis der Viszeralchirurgie. Gastroenterologische Chirurgie

Zusammenfassung

In Mitteleuropa überwiegt das stumpfe Abdominaltrauma als Folge von Verkehrs- und Arbeitsunfällen gegenüber penetrierenden Abdominalverletzungen. Bei 20–40% der polytraumatisierten Patienten ist die Abdominalregion mitbeteiligt (Bardenheuer et al. 1997; Staib et al. 2004) und ist, obwohl das Schädel-Hirn-Trauma die häufigste Ursache der Frühletalität beim polytraumatisierten Patienten darstellt, mit 19% zu einem beachtlichen Teil an der Gesamtletalität von polytraumatisierten Patienten beteiligt. Im Gegensatz zum Schädel-Hirn-Trauma finden sich die meisten Todesfälle beim Abdominaltrauma in den ersten 6 h nach Klinikeintritt, was die zeitliche Priorität bei Diagnostik und Therapie abdomineller Verletzungen begründet (Demetriades et al. 2004).

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Literatur

  • American College of Surgeons (2008) Advanced trauma life support for doctors, 8th ed. Chicago/Ill

    Google Scholar 

  • Balogh Z, McKinley BA, Cocanour CS, et al. (2003) Supranormal trauma resuscitation causes more cases of abdominal compartment syndrome. Arch Surg 138: 637–643

    Article  PubMed  Google Scholar 

  • Bardenheuer M, Obertacke U, Schmit-Neuenburg K (1997) Das DGU Traumaregister zur Standortbestimmung des schweren Traumas in Deutschland. Unfallchirurg 268:269–273

    Google Scholar 

  • Blackbourne LH, Soffer D, McKenny M, et al. (2004) Secondary ultrasound examination increases the sensitivity of the FAST exam in blunt trauma. J Trauma 57(5): 934–938

    Article  PubMed  Google Scholar 

  • Boffard K (2007) Manual of definitive surgical trauma care, 2nd ed. London/GB

    Google Scholar 

  • Brown CVR, Velmahos GC, Neville AL, et al. (2005) Hemodynamically »stable« patients with peritonitis after penetrating abdominal trauma. Arch Surg 140: 767–772

    Article  PubMed  Google Scholar 

  • Carillo E, Bergamini T, Miller F, et al. (1997) Abdominal vascular injuries. J Trauma 43(1):164–171

    Article  Google Scholar 

  • Carillo EH, Richardson J, Miller F (1996) Evolution in the management of duodenal injuries. J Trauma 40:1037–1046

    Article  Google Scholar 

  • Carillo EH, Spain DA, Wohltmann CD, et al. (1999) Interventional techniques are useful adjuncts in non-operative management of hepatic injuries. J Trauma 46: 619–624

    Article  Google Scholar 

  • Como JJ, Bokhari F, Chiu WC, et al. (2010) Practice management guidelines for selective nonoperative management of penetrating abdominal trauma. J Trauma 68(3):721–733

    Article  PubMed  Google Scholar 

  • Cox JC, Fabian TC, Maish GO, et al. (2005) Routine follow-up imaging is unnecessary in the management of blunt hepatic injury. J Trauma 59: 1175–1180

    Article  PubMed  Google Scholar 

  • Delgado G, Barletta JF, Kanij S, et al. (2002) Characteristics of prophylactic antibiotic strategies after penetrating abdominal trauma at level I urban trauma center: a comparison with the EAST guidelines. J Trauma 53(4):673–678

    Article  PubMed  CAS  Google Scholar 

  • Demetriades D, Murray J, Charalambides K, et al. (2004) Trauma facilities: time and location of hospital deaths. J Am Coll Surg 198(1): 20–26

    Article  PubMed  Google Scholar 

  • Demetriades D, Murray JA, Chan L (2001) Penetrating colon injuries requiring resection: Diversion or primary anastomosis? An AAST prospective multicenter study. J Trauma 50(5):765–775

    Article  PubMed  CAS  Google Scholar 

  • Deunk J, Brink M, Dekker HM, et al. (2009) Routine versus selective computed tomography of the abdomen, pelvis, and lumbar spine in blunt trauma: a prospective evaluation. J Trauma 66: 1108–1117

    Article  PubMed  Google Scholar 

  • Diamond IR, Hamilton PA, Garber AB, et al. (2009) Extravasation of intravenous computed tomography scan contrast in blunt abdominal and pelvic trauma. J Trauma 66: 1102–1107

    Article  PubMed  Google Scholar 

  • Ekeh AP, Saxe J, Walusimbi M, et al. (2008) Diagnosis of blunt intestinal and mesenteric injury in the era of multidetector CT technology- are results better? J Trauma 65:354–359

    Article  PubMed  Google Scholar 

  • Ertel W, Oberholzer A, Platz A, et al. (1998) Abdominal compartment syndrome after severe abdominal and/or pelvic trauma. Langenbecks Arch Chir suppl Kongressbd 115:1189–1190

    PubMed  CAS  Google Scholar 

  • Ertl W, Trentz O (1996) Das stumpfe und penetrierende Abdominaltrauma. Unfallchirurg 99:288

    Google Scholar 

  • Fabian TC, Mangiante EC, White TJ, et al. (1986) A prospective study of 91 patients undergoing both computed tomography and peritoneal lavage following blunt abdominal trauma. J Trauma 26:602–608

    Article  PubMed  CAS  Google Scholar 

  • Galban C, Montejo JC, Mesejo A, et al. (2000) An immune-enhancing enteral diet reduces mortalitiy rate and episodes of bacteraemia in septic intensive care unit patients. Crit Care Med 28:643–648

    Article  PubMed  CAS  Google Scholar 

  • Gonzalez RP, Ickler J, Gachassin P (2001) Complementary roles of diagnostic peritoneal lavage and computed tomography in the evaluation of blunt abdominal trauma. J Trauma 51(6):1128–1136

    Article  PubMed  CAS  Google Scholar 

  • Haan J, Obeid NI, Kramer M (2003) Protocol-driven nonoperative management in patients with blunt splenic trauma and minimal associated injury decreases length of stay. J Trauma 55:317–322

    Article  PubMed  Google Scholar 

  • Hagiwara A, Murata A, Matsuda T, et al. (2002) The efficacy and limitations of transarterial embolization for severe hepatic injury. J Trauma 52(6):1091–1096

    Article  PubMed  Google Scholar 

  • Hoff WS, Holevar M, Nagy KK (2002) Practice management guidelines for the evaluation of blunt abdominal trauma: The EAST practice management guidelines work group. J Trauma 53:602–615

    Article  PubMed  Google Scholar 

  • Ivatury RR, Simon RJ, Stahl WM (1993) A critical evaluation of laparoscopy in penetrating abdominal trauma. J Trauma 34: 822–828

    Article  PubMed  CAS  Google Scholar 

  • Jansen JO, Yule SR, Loudon MA (2008) Investigation of blunt abdominal trauma. BMJ 336:938–942

    Article  PubMed  Google Scholar 

  • Johnson JW, Gracias VH, Gupta R, et al. (2002) Hepatic angiography in patients undergoing damage control laparotomy. J Trauma 52(6): 1102–1106

    Article  PubMed  Google Scholar 

  • Johnson JW, Gracias VH, Schwab CW, et al. (2001) Evolution in damage control for exsanguinating penetrating abdominal injury. J Trauma 51:261–271

    Article  PubMed  CAS  Google Scholar 

  • Kawahara NT, Alster C, Fujimura I, et al. (2009) Standard examination system for laparoscopy in penetrating abdominal trauma. J Trauma 67(3): 589–595

    Article  PubMed  Google Scholar 

  • Knudson MM, Harrison PB, Hoyt DB, et al. (2000) Outcome after major renovascular injuries: A western trauma association multicenter report. J Trauma 49(6):1116–1122

    Article  PubMed  CAS  Google Scholar 

  • Kozar RA, Moore FA, Cothren CC, et al. (2006) Risk factors for hepatic morbidity following nonoperative management. Arch Surg 141: 451–459

    Article  PubMed  Google Scholar 

  • Kudsk K, Sheldon G (1986) Retroperitoneales Hämatom. In: Biaisdell F, Trunkey D (Hrsg) Bauchtrauma. Enke, Stuttgart, S 240–252

    Google Scholar 

  • Lin B-C, Chen R-J, Fang J-F, et al. (2004) Management of blunt major pancreatic injury. J Trauma 56(4):774–778

    Article  PubMed  Google Scholar 

  • Livingston DH, Lavery RF, Passannante MR, et al. (1998) Admission or observation is not necessary after a negative abdominal computed tomographic scan with suspected blunt abdominal abdominal trauma: results of a prospective, multi-institutional trial. J Trauma 44:272–282

    Article  Google Scholar 

  • London JA, Parry L, Galante J, et al. (2008) Safety of early mobilization of patients with blunt solid organ injuries. Arch Surg 143 (10): 972–976

    Article  PubMed  Google Scholar 

  • Lucas C, Ledgerwood A (1975) Factors influencing the outcome after blunt duodenal injury. J Trauma 15:839–846

    Article  PubMed  CAS  Google Scholar 

  • Luchette FA, Borzotta AP, Croce MA, et al. (2000) Practice management guidelines for prophylactic antibiotic use in penetratine abdominal trauma: the EAST practice management guidelines work group. J Trauma 48(3):508–518

    Article  PubMed  CAS  Google Scholar 

  • Malhotra AK, Fabian TC, Croce MA, et al. (2000) Blunt hepatic injury: a paradigm shift from operative to nonoperative management in the 1990’s. Ann Surg 231:804–813

    Article  PubMed  CAS  Google Scholar 

  • Marik PE, Zaloga GP (2001) Early enteral nutrition in acutely ill patients: A systematic review. Crit Care Med 29(12):2264–2270

    Article  PubMed  CAS  Google Scholar 

  • McAninch J (1986) Urogenitaltrakt. In: Blaisdell F, Trunkey D (Hrsg) Bauchtrauma. Enke, Stuttgart, S 172–196

    Google Scholar 

  • McCarter FD, Luchette FA, Molloy M, et al. (2000) Institunional and individual learning curves for focused abdominal ultrasound for trauma. Ann Surg 231(5):689–700

    Article  PubMed  CAS  Google Scholar 

  • McKenzie S, Kortbeek JB, Mulloy R, et al. (2004) Recent experiences with a multidisciplinary approach to complex hepatic trauma. Injury 35: 869–877

    Article  Google Scholar 

  • Mohr AM, Lavery RF, Barone A, et al. (2003) Angiographic embolization for liver injuries: low mortality, high morbidity. J Trauma 55(6): 1077–1082

    Article  PubMed  Google Scholar 

  • Moore E, Shackford S, Pachter H, et al. (1989) Organ injury scaling: spleen, liver and kidney. J Trauma 29:1664–1666

    Article  PubMed  CAS  Google Scholar 

  • Moore EE, Cogbill TH, Jurkovich GJ, et al. (1995) Organ injury scaling: spleen and liver (1994 revision). J Trauma 38: 323–324

    Article  PubMed  CAS  Google Scholar 

  • Moore EE, Moore JB, van Duzer-Moore S, et al. (1980) Mandatory laparotomy for gunshot wounds penetrating the abdomen. Am J Surg 140: 847–851

    Article  PubMed  CAS  Google Scholar 

  • Moore FA, Davis JW, Moore EE, et al. (2008) Western trauma association (WTA) critical decisions in trauma: management of adult blunt splenic trauma. J Trauma 65(5):1007–1011

    Article  PubMed  Google Scholar 

  • Morris JA, Eddy VA, Blinman TA, et al. (1993) The staged celiotomy for trauma. Ann Surg 217(5):576–84

    Article  PubMed  Google Scholar 

  • Navsaria PH, Graham R, Nicol A (2001) A new approach to extraperitoneal rectal injuries: laparoscopy and diverting loop sigmoid colostomy. J Trauma 51:532–535

    Article  PubMed  CAS  Google Scholar 

  • Peitzman AB, Heil B, Rivera L, et al. (2000) Blunt splenic injury in adults: multi-institional study of the eastern association for the surgery of trauma. J Trauma 49(2): 177–189

    Article  PubMed  CAS  Google Scholar 

  • Poletti PA, Mirvis SE, Shanmuganathan K, et al. (2004) Blunt abdominal trauma patients: Can organ injury be excluded without performing computed tomography? J Trauma 57(5): 1072–1081

    Article  PubMed  Google Scholar 

  • Richardson JD, Franklin GA, Lukan JK (2000) Evolution in the management of hepatic trauma: a 25-year perspective. Ann Surg 232(2): 324–330

    Article  Google Scholar 

  • Rotondo MF, Zonies DH (1997) The damage control sequence and underlying logic. Surg Clin North Am 77(4):761–777

    Article  PubMed  CAS  Google Scholar 

  • Saggi BH, Sugerman HJ, Ivatury RR, et al. (1998) Abdominal compartment syndrome. J Trauma 45(3):597–609

    Article  PubMed  CAS  Google Scholar 

  • Salim A, Sangthong B, Martin M, et al. (2006) Use of computed tomography in anterior abdominal stab wounds. Arch Surg 141:745–752

    Article  PubMed  Google Scholar 

  • Shatz DV (2002) Vaccination practices among North American trauma surgeons in splenectomy for trauma. J Trauma 53:950–956

    Article  PubMed  Google Scholar 

  • Simon RJ, Rabin J, Kuhls D (2002) Impact of increased use of laparoscopy on negative laparotomy after penetrating trauma. J Trauma 53:297–302

    Article  PubMed  Google Scholar 

  • Staib L, Aschoff AJ, Henne-Bruns D (2004) Abdominaltrauma: Chirurg 75:447–467

    Article  PubMed  CAS  Google Scholar 

  • Starzl T, Kaupp H, Beheler E, et al. (1962) The treatment of wound of the inferior vena cava. Surgery 51:195–204

    PubMed  CAS  Google Scholar 

  • Sung CK, Kim KH (1996) Missed injuries in abdominal trauma. J Trauma 41(2):276–282

    Article  PubMed  CAS  Google Scholar 

  • Tan K, Bang S, Vijayan A, et al. (2009) Hepatic enzymes have a role in the diagnosis of hepatic injury after blunt abdominal trauma. Injury 40:978–983

    Article  PubMed  Google Scholar 

  • Thadepalli H, Gorbach SL, Broido PW, et al. (1973) Abdominal trauma, anaerobes and antibiotics. Surg Gynaecol Obstet 137:270–276

    CAS  Google Scholar 

  • Timaran CH, Daley BJ, Enderson BL (2001) Role of duodenography in the diagnosis of blunt duodenal injuries. J Trauma 51:648–651

    Article  PubMed  CAS  Google Scholar 

  • Trentz O, Käch K (1995) Abdomen. In: Rütter A, Trentz O, Wagner A (Hrsg) Unfallchirurgie. Urban & Schwarzenberg, München Wien Baltimore, S 341–381

    Google Scholar 

  • Velmahos GC, Tabbara M, Gross R, et al. (2009) Blunt pancreatoduodenal injury. Arch Surg 144(5):413–419

    Article  PubMed  Google Scholar 

  • Williams MD, Watts D, Fakhry S (2003) Colon injury after blunt abdominal trauma: results of the EAST multi-institutional hollow viscus injury study. J Trauma 55:906–912

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Chirurgie, Unfallchirurgie, Kantonsspital Luzern, Spitalstrasse, 6000, Luzern, Schweiz

    Dr. med. J. Rosenkranz

  2. Kantonsspital Luzern, Spitalstrasse, 6000, Luzern, Schweiz

    Prof. Dr. med. R. Babst (Chefarzt Chirurgie A und Leiter Unfallchirurgie)

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  1. Dr. med. J. Rosenkranz
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  2. Prof. Dr. med. R. Babst
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Editor information

Editors and Affiliations

  1. Universitätsklinikum Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg

    Jörg Rüdiger Siewert (Leitender Ärztlicher Direktor und Vorstandsvorsitzender) (Leitender Ärztlicher Direktor und Vorstandsvorsitzender)

  2. Universitätsklinikum Marburg, Baldingerstraße, 35043, Marburg

    Matthias Rothmund (Dekan) (Dekan)

  3. Universitätsklinik Aachen, Pauwelsstraße 30, 52074, Aachen

    Volker Schumpelick (Direktor der Chirurgischen) (Direktor der Chirurgischen)

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Rosenkranz, J., Babst, R. (2011). Spezielle chirurgische Prinzipien in der Behandlung des traumatischen Abdomens. In: Siewert, J.R., Rothmund, M., Schumpelick, V. (eds) Praxis der Viszeralchirurgie. Gastroenterologische Chirurgie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-14223-9_22

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  • DOI: https://doi.org/10.1007/978-3-642-14223-9_22

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-14222-2

  • Online ISBN: 978-3-642-14223-9

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