Trauma Operative Procedures: Timing of Surgery and Priorities

  • G. Sganga
  • G. Brisinda
  • M. Castagneto
Conference paper


Abdominal trauma (AT) remains a leading cause of morbidity and mortality among all age groups. Its true frequency is unknown, as is the incidence of out-of-hospital deaths [1, 2]. Moreover, it has been noted that AT occurs in approximately 25% of major trauma victims, and often involves multiple organ injuries. These involving head and/or thoracic injuries are common, and may complicate AT management [1, 2, 3, 4, 5, 6, 7, 8].


Abdominal Trauma Primary Repair Nonoperative Management Abdominal Compartment Syndrome Pancreatic Injury 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Mackersie RC (2001) Abdominal trauma. In: Norton JA, Bollinger RR, Chang AE, Lowry SF, Mulvihill SJ, Pass HI, Thompson RW (eds) Surgery. Basic science and clinical evidence. Springer, Berlin Heidelberg New York, pp 825–845Google Scholar
  2. 2.
    Hoyt DB Coimbra R Winchell RJ 2001 Management of acute trauma. In Townsend CM ed Sabiston — Textbook of surgery. Saunders Philadelphia pp 311–344Google Scholar
  3. 3.
    National Center for Injury Prevention and Control (2001)
  4. 4.
    Fabian TC, Croce MA (1996) Abdominal trauma, including indication for celiotomy. In: Mattox KL, Moore EE, Feliciano DV (eds) Trauma. 3rd edn, Appleton and Lange, Stanford: 441–460Google Scholar
  5. 5.
    Alonso M, Brathwaite C, Garcia V, et al (2000) Practice management guidelines for the nonoperative management of blunt injury to the liver and spleen. Eastern Association for the Surgery of Trauma.
  6. 6.
  7. 7.
    American College of Surgeons, ACS (2000) Abdominal trauma algorithm. Bull Am Coll Surg 80: 6Google Scholar
  8. 8.
    Salomone JA (2000) Abdominal trauma. http://www.emedicinecom/emerg/topic1.html
  9. 9.
    Sauaia A, Moore FA, Moore EE, et al (1995) Epidemiology of trauma deaths. J Trauma 38: 185–193PubMedCrossRefGoogle Scholar
  10. 10.
    Mattox K (1997) Introduction, background, and future projections of damage control surgery. Surg Clin North Am 77: 753–759PubMedCrossRefGoogle Scholar
  11. 11.
    Hirshberg A, Mattox KL (1995) Planned reoperation for severe trauma. Ann Surg 222: 3–8PubMedCrossRefGoogle Scholar
  12. 12.
    Rotondo MF, Schwab CW, McGonial MD, et al (1993) Damage control: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma 35: 375–382PubMedCrossRefGoogle Scholar
  13. 13.
    Halstead WS (1913) The employment of fine silk in preference to catgut and the advantages of transfixing tissues and vessels in controlling hemorrhage. Also an account of the introduction of gloves, gutta-percha tissue and silver foil. JAMA 60: 1119CrossRefGoogle Scholar
  14. 14.
    Schroeder WE (1906) The process of liver hemostasis. Reports of cases. Surg Gynecol Obstet 2: 52Google Scholar
  15. 15.
    Moore EE (1996) Staged laparotomy for the hypothermia, acidosis, and coagulopathy syndrome. Am J Surg 172: 405–410PubMedCrossRefGoogle Scholar
  16. 16.
    Feliciano DV, Mattox KL, Jordan GL, et al (1981) Packing for control of hepatic hemorrhage: a reappraisal. J Trauma 21: 285–290PubMedCrossRefGoogle Scholar
  17. 17.
    Svoboda JA, Peter ET, Dang CV, et al (1982) Severe liver trauma in the face of coagulopathy: a case for temporary packing early reexploration. Am J Surg 144: 717–721PubMedCrossRefGoogle Scholar
  18. 18.
    Stone HH, Strom PR, Mullins RJ (1983) Management of the major coagulopathy with onset during laparotomy. Ann Surg 197: 532–535PubMedCrossRefGoogle Scholar
  19. 19.
    Burch JM, Denton JR, Noble RD (1997) Physiologic rationale for damage control surgery. Surg Clin North Am 77: 779–782PubMedCrossRefGoogle Scholar
  20. 20.
    Hirshberg A, Waiden R (1997) Damage control for abdominal trauma. Surg Clin North Am 77: 813–820PubMedCrossRefGoogle Scholar
  21. 21.
    Morris JA, Eddy VA, Binman TA, et al (1993) The staged celiotomy for trauma: issues in unpacking and reconstruction. Ann Surg 217: 576–586PubMedCrossRefGoogle Scholar
  22. 22.
    Moore EE, Burch JM, Franciose RJ, et al (1998) Staged physiologic restoration and damage control surgery. World J Surg 22: 1184–1191PubMedCrossRefGoogle Scholar
  23. 23.
    Reed RL, Bracey AW, Hudson JD, et al (1990) Hypothermia and blood coagulation: Dissociation between enzyme activity and clotting factor levels. Circ Shock 32: 141PubMedGoogle Scholar
  24. 24.
    Gentilello LM, Cobean RA, Offner PJ, et al (1992) Continuous arteriovenous rewarming: rapid reversal of hypothermia in critically ill patients. J Trauma 32: 316–327PubMedCrossRefGoogle Scholar
  25. 25.
    Martin RR, Byrne M (1997) Postoperative care and complications of damage control surgery. Surg Clin North Am 77: 919–924Google Scholar
  26. 26.
    Burch JM, Ortiz VB, Richardson RJ, et al (1992) Abbreviated laparotomy and planned reoperation for critically injured patients. Ann Surg 215: 476–482PubMedCrossRefGoogle Scholar
  27. 27.
    Pachter HL, Knudson MM, Esrig B, et al (1996) Status of nonoperative management of blunt hepatic injuries in 1995: a multicenter experience with 404 patients. J Trauma 40: 31–38PubMedCrossRefGoogle Scholar
  28. 28.
    Burch JM, Moore EE, Moore FA, Franciose R (1996) The abdominal compartment syndrome. Surg Clin North Am 76: 833–842PubMedCrossRefGoogle Scholar
  29. 29.
    Mirvis SE, Whitley NO, Vainwright JR, Gens DR (1989) Blunt hepatic trauma in adults: CT-base classification and correlation with prognosis and treatment. Radiology 171: 27–32PubMedGoogle Scholar
  30. 30.
    Hiatt JR, Harrier HD, Koenig BV, Ransom KJ (1990) Nonoperative management of major blunt liver injury with hemoperitoneum. Arch Surg 125: 101–103PubMedCrossRefGoogle Scholar
  31. 31.
    Federico JA, Homer WR, Clark DE, Isler RJ (1990) Blunt hepatic trauma. Nonoperative management in adults Arch Surg 125: 905–909CrossRefGoogle Scholar
  32. 32.
    Hollands MJ, Little JM (1991) Non-operative management of blunt liver injuries. Br J Surg 78: 968–972PubMedCrossRefGoogle Scholar
  33. 33.
    Bynoe RP, Bell RM, Miles WS, et al (1992) Complications of nonoperative management of blunt hepatic injuries. J Trauma 32: 308–315PubMedCrossRefGoogle Scholar
  34. 34.
    Pachter HL, Spencer FC, Hofstetter SR, et al (1992) Significant trends in the treatment of hepatic trauma. Experience with 411 injuries. Ann Surg 215: 492–502PubMedCrossRefGoogle Scholar
  35. 35.
    Meredith JW, Young JS, Bowling J, Roboussin D (1994) Nonoperative management of blunt hepatic trauma: The exception or the rule? J Trauma 36: 529–535PubMedCrossRefGoogle Scholar
  36. 36.
    Boone DC, Federle M, Billiar TR, et al (1995) Evolution of management of major hepatic trauma: identification of patterns of injury. J Trauma 39: 344–355PubMedCrossRefGoogle Scholar
  37. 37.
    Croce MA, Fabian TC, Menke PG, et al (1995) Nonoperative management of blunt hepatic trauma is the treatment of choice for hemodynamically stable patients. Results of a prospective trial. Ann Surg 221: 744–753PubMedCrossRefGoogle Scholar
  38. 38.
    Brasel KJ, DeLisle CM, Olson CJ, Borgstrom DC (1997) Trends in the management of hepatic injury. Am J Surg 174: 674–677PubMedCrossRefGoogle Scholar
  39. 39.
    Carrillo EH, Platz A, Miller FB, et al (1998) Non-operative management of blunt hepatic trauma. Br J Surg 85: 461–468PubMedCrossRefGoogle Scholar
  40. 40.
    Moodley J, Singh B, Lalloo S, et al (2001) Non-operative management of haemobilia. Br J Surg 88: 1073–1076PubMedCrossRefGoogle Scholar
  41. 41.
    Green MHA, Duell RM, Johnson CD, Jamieson NV (2001) Haemobilia. Br J Surg 88: 773–786PubMedCrossRefGoogle Scholar
  42. 42.
    Malangoni MA, Levine AW, Droege EA, et al (1984) Management of injury to the spleen in adults. Results of early operation and observation. Ann Surg 200: 702–705PubMedCrossRefGoogle Scholar
  43. 43.
    Bitseff EL, Adkins, Jr RB (1984) Splenic trauma: a trial at selective management. South Med J 77: 1286–1290PubMedCrossRefGoogle Scholar
  44. 44.
    Mahon PA, Sutton JE (1985) Nonoperative management of adult splenic injury due to blunt trauma: a warning. Am J Surg 149: 716–721PubMedCrossRefGoogle Scholar
  45. 45.
    Tom WW, Howells GA, Bree RL, et al (1985) A nonoperative approach to the adult ruptured spleen sustained from blunt trauma. Am Surg 51: 367–371PubMedGoogle Scholar
  46. 46.
    Cogbill TH, Moore EE, Jurkovich GJ, et al (1989) Nonoperative management of blunt splenic trauma: a multicenter experience. J Trauma 29: 1312–1317PubMedCrossRefGoogle Scholar
  47. 47.
    Elmore JR, Clark DE, Isler RJ, Horner WR (1989) Selective nonoperative management of blunt splenic trauma in adults. Arch Surg 124: 581–585PubMedCrossRefGoogle Scholar
  48. 48.
    Longo WE, Baker CC, McMillen MA, et al (1989) Nonoperative management of adult blunt splenic trauma. Criteria for successful outcome. Ann Surg 210: 626–629PubMedCrossRefGoogle Scholar
  49. 49.
    Pachter HL, Spencer FC, Hofstetter SR, et al (1990) Experience with selective operative and nonoperative treatment of splenic injuries in 193 patients. Ann Surg 211: 583–589PubMedCrossRefGoogle Scholar
  50. 50.
    Koury HI, Peschiera JL, Welling RE (1991) Non-operative management of blunt splenic trauma: a 10-year experience. Injury 22: 349–352PubMedCrossRefGoogle Scholar
  51. 51.
    Schurr MJ, Fabian TC, Gavant M, et al (1995) Management of blunt splenic trauma: computed tomographic contrast blush predicts failure of nonoperative management. J Trauma 39: 507–512PubMedCrossRefGoogle Scholar
  52. 52.
    Godley CD, Warren RL, Sheridan RL, McCabe CJ (1996) Nonoperative management of blunt splenic injury in adults: age over 55 years as a powerful indicator for failure. J Am Coll Surg 183: 133–139PubMedGoogle Scholar
  53. 53.
    Wasvary H, Howells G, Villalba M, et al (1997) Nonoperative management of adult blunt splenic trauma: a 15-year experience. Am Surg 63: 694–699PubMedGoogle Scholar
  54. 54.
    Cocanour CS, Moore FA, Ware DN, et al (1998) Delayed complications of nonoperative management of blunt adult splenic trauma. Arch Surg 133: 619–624PubMedCrossRefGoogle Scholar
  55. 55.
    Davis KA, Fabian TC, Croce MA, et al (1998) Improved success in nonoperative management of blunt splenic injuries: embolization of splenic artery pseudoaneurysms J Trauma 44: 1008–1013PubMedCrossRefGoogle Scholar
  56. 56.
    Stone HH, Fabian TC (1979) Management of duodenal wounds. J Trauma 19: 334–339PubMedCrossRefGoogle Scholar
  57. 57.
    Stone HH, Fabian TC, Satiani B, Turkleson ML (1981) Experiences in the management of pancreatic trauma. J Trauma 21: 257–262PubMedCrossRefGoogle Scholar
  58. 58.
    Martin TD, Feliciano DV, Mattox KL, Jordan GL (1983) Severe duodenal injuries. Treatment with pyloric exclusion and gastrojejunostomy. Arch Surg 118: 631–635PubMedCrossRefGoogle Scholar
  59. 59.
    Oreskovich MR, Carrico CJ (1984) Pancreaticoduodenectomy for trauma: a viable option? Am J Surg 147: 618–623PubMedCrossRefGoogle Scholar
  60. 60.
    Ivatury RR, Nallathambi M, Gaudino J, et al (1985) Penetrating duodenal injuries. Analysis of 100 consecutive cases. Ann Surg 202: 153–158PubMedCrossRefGoogle Scholar
  61. 61.
    Feliciano DV, Martin TD, Cruse PA, et al (1987) Management of combined pancreatoduodenal injuries. Ann Surg 205: 673–680PubMedCrossRefGoogle Scholar
  62. 62.
    Cogbill TH, Moore EE, Feliciano DV, et al (1990) Conservative management of duodenal trauma: a multicenter perspective. J Trauma 30: 1469–1475PubMedCrossRefGoogle Scholar
  63. 63.
    Ivatury RR, Nallathambi M, Rao P, Stahl WM (1990) Penetrating pancreatic injuries. Analysis of 103 consecutive cases. Am Surg 56: 90–95PubMedGoogle Scholar
  64. 64.
    Cogbill TH, Moore EE, Morris, Jr JA, et al (1991) Distal pancreatectomy for trauma: a multicenter experience. J Trauma 31: 1600–1606PubMedCrossRefGoogle Scholar
  65. 65.
    Madiba TE, Mokoena TR (1995) Favourable prognosis after surgical drainage of gunshot, stab or blunt trauma of the pancreas Br J Surg 82: 1236–1239PubMedCrossRefGoogle Scholar
  66. 66.
    Akhrass R, Yaffe MB, Brandt CP, et al (1997) Pancreatic trauma: a ten-year multi-institutional experience. Am Surg 63: 598–604PubMedGoogle Scholar
  67. 67.
    Young PR, Meredith JW, Baker CC, et al (1998) Pancreatic injuries resulting from penetrating trauma: a multi-institution review. Am Surg 64: 838–843PubMedGoogle Scholar
  68. 68.
    Shannon FL, Moore EE (1985) Primary repair of the colon: when is it a safe alternative? Surgery 98: 851–860PubMedGoogle Scholar
  69. 69.
    Chappuis CW, Frey DJ, Dietzen CD, et al (1991) Management of penetrating colon injuries. A prospective randomized trial. Ann Surg 213: 492–497PubMedCrossRefGoogle Scholar
  70. 70.
    Schultz SC, Magnant CM, Richman MF, et al (1993) Identifying the low-risk patient with penetrating colonic injury for selective use of primary repair. Surg Gynecol Obstet 177: 237–242PubMedGoogle Scholar
  71. 71.
    Ivatury RR, Gaudino J, Nallathambi MN, et al (1993) Definitive treatment of colon injuries: a prospective study. Am Surg 59: 43–49PubMedGoogle Scholar
  72. 72.
    Sasaki LS, Allaben RD, Golwala R, Mittal VK (1995) Primary repair of colon injuries: a prospective randomized study J Trauma 39: 895–901PubMedCrossRefGoogle Scholar
  73. 73.
    Gonzalez RP, Merlotti GJ, Holevar MR (1996) Colostomy in penetrating colon injury: is it necessary? J Trauma 41: 271–275PubMedCrossRefGoogle Scholar
  74. 74.
    Cue JI, Cryer HG, Miller FB et al (1990) Packing and planned reexploration for hepatic and retroperitoneal hemorrhage — critical refinements of a useful technique. J Trauma 30: 1007–1013PubMedCrossRefGoogle Scholar
  75. 75.
    Carvillo C, Fogler RJ, Shafton GW (1993) Delayed gastrointestinal reconstruction following massive abdominal trauma. J Trauma 34: 233–235CrossRefGoogle Scholar
  76. 76.
    Schein M, Wittman DH, Aprahamian CC, Condon RE (1995) The abdominal compartment syndrome—the physiological and clinical consequences of raised intra-abdominal pressure. J Am Coll Surg 180: 745–753PubMedGoogle Scholar
  77. 77.
    Sganga G, Brisinda G, Castagneto M (2001) Peritonitis: priorities and management strategies. In: Saene HKF van, Sganga G, Silvestri L (eds) Infections in critically ill: an ongoing challenge. Springer, Berlin Heidelberg New York, pp 23–33CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2002

Authors and Affiliations

  • G. Sganga
    • 1
  • G. Brisinda
    • 1
  • M. Castagneto
    • 1
  1. 1.Department of Surgery, Division of Organ TransplantationCatholic University, University Hospital “A. Gemelli” and CNRRomeItaly

Personalised recommendations