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Eviszeration von Darm nach Stichverletzung des Abdomens

Häufigkeit und klinische Aspekte des klinischen Schockraummanagements

Evisceration of intestines following abdominal stab wounds

Epidemiology and clinical aspects of emergency room management

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Zusammenfassung

Hintergrund und Fragestellung

Es wird die Häufigkeit und die klinischen Parameter von abdominellen Verletzungen mit Eviszeration von Darm im Schockraum ermittelt.

Studiendesign und Untersuchungsmethoden

Wir führen eine retrograde Kohortenanalyse aller Schockraumpatienten des Chris Hani Baragwanath Academic Hospitals, Soweto, Johannesburg, Südafrika im Zeitraum von 9/2000–5/2005 durch.

Ergebnisse

Von 9010 Patienten erlitten 4390 penetrierende Verletzungen, davon 71 Patienten mit Eviszeration von Darm. 8/71 der Eviszerationen von Darm waren bei singulären Schussverletzungen, während 60/71 der Eviszerationen aufgrund von singulären Stichverletzungen zu verzeichnen waren. 3 Patienten erlitten multiple Verletzungen. Herzfrequenz, Blutdruck und Schockindex in Bauchstichpatienten mit und ohne Eviszeration waren nicht signifikant unterschiedlich, sodass eine vagale Überstimulierung aufgrund von Zug am Mesenterium weder durch Bradykardie noch durch Hypotonie belegt wurde. Die Mortalität betrug 1/71(1,6 %; Schockraumdurchschnitt 4,2 %).

Schlussfolgerungen

Bei 71 Patienten mit Eviszeration von Darm fand sich weder eine erhöhte Schockraummortalität noch eine Kreislaufinstabilität. Die Patienten waren ausreichend kreislaufstabil, um umfassende präoperative Diagnostik durchzuführen.

Abstract

Study aim

The aim of the study was an estimation of the incidence and clinical aspects of emergency room (ER) parameters of penetrating abdominal injury patients with bowel evisceration.

Study design and methods

The study involved a retrospective cohort analysis of ER data from the Chris Hani Baragwanath Academic Hospitals, Soweto, Johannesburg, South Africa between September 2000 to May 2005.

Results

Out of 9,010 ER patients, 4,390 suffered penetrating injuries with 8 out of 71 eviscerations due to a single gunshot wound, 60 out of 71 eviscerations due to single stab wounds and 3 further patients suffered multiple injuries. The ER mortality was 1 out of 71(1.6 %) with an average ER mortality of 4.2 %. The only death seen was a single abdominal gunshot wound with vascular injury. The causative mortality due to abdominal stab wounds with evisceration of the bowels was therefore zero. The heart rate in patients with abdominal stab wounds with and without bowel evisceration showed no significant difference, thus mesentery tearing or vagal overstimulation could not be seen, neither with bradycardia nor hypotension.

Conclusion

Evisceration itself is not a cause for increased mortality or cardiovascular instability seen in the ER. There is ample time for diagnostic procedures before laparotomy is performed.

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Danksagung

Diese Daten wurden erhoben in Zusammenhang mit dem Forschungsprojekt „Incidence of in theatre surgical treatment of gunshot wounds (gsw) and stab chest wounds from resus room patients and consecutive fitness to MEDEVAC“ (Operationspflichtigkeit der den Schockraum erreichenden Schussverletzungen des Thorax im Vergleich zu Stichverletzungen des Thorax und Zeit bis zum Erreichen der MEDEVAC-Faehigkeit) des Sanitätsamtes der Bundeswehr und dem Department of Trauma and Burns of the Chris Hani Baragwanath Academic Hospital, SOWETO, Medical School, University of the Witwatersrand, Johannesburg, Republic of South Africa, Research project number: M-SAB1-5-A015 erhoben. Die Autoren danken der Bundeswehr für die Unterstützung ihrer wissenschaftlichen Arbeit und die Möglichkeit, diese Daten zu publizieren.

Interessenkonflikt

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Authors and Affiliations

  1. Department of Trauma and Burns, Chris Hani Baragwanath Academic Hospital, Johannesburg, Südafrika

    D. Doll & E. Degiannis

  2. Chirurgische Klinik, St. Marienhospital Vechta, Akademisches Lehrkrankenhaus der Medizinischen Hochschule Hannover, Marienstraße 6–8, 49377, Vechta, Deutschland

    D. Doll & C. Hönemann

  3. Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Deutschland

    E. Matevossian

  4. Abteilung für Chirurgie, Bundeswehrkrankenhaus Berlin, Lehrkrankenhaus der Charité, Berlin, Deutschland

    K. Kayser

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  1. D. Doll
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  2. E. Matevossian
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  4. E. Degiannis
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Correspondence to D. Doll.

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Doll, D., Matevossian, E., Kayser, K. et al. Eviszeration von Darm nach Stichverletzung des Abdomens. Unfallchirurg 117, 624–632 (2014). https://doi.org/10.1007/s00113-013-2390-5

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