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Stammverletzung: Abdomen

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Management des Schwerverletzten

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Zusammenfassung

Abdominalverletzungen im Rahmen eines stumpfen Bauchtraumas können zu einem hohen Prozentsatz nach exakter CT-Diagnostik unter engmaschiger intensivmedizinischer Überwachung und Therapie konservativ geführt werden. In extremen Blutungssituationen haben sich die Damage-Control-Prinzipien mit einer abgekürzten Laparotomie zur Blutungs- und Kontaminationskontrolle sowie einer anschließenden intensivmedizinischen Stabilisierung des Patienten bewährt. Beim penetrierenden Abdominaltrauma kann zur Vermeidung einer negativen Laparotomie beim kreislaufstabilen Patienten mit Verdacht auf Verletzung des vorderen Faszienblattes eine diagnostische Laparoskopie erfolgen. Eine Indikation zur notfallmäßigen Laparotomie besteht bei abdominellen Blutungen mit hämorrhagischem Schock, einer Peritonitis als Folge einer Hohlorganverletzung und der Eviszeration von Eingeweiden. Trotz einer stetigen Weiterentwicklung der CT-Technik und neuerer interventioneller Therapieverfahren bleibt das Abdominaltrauma weiterhin eine diagnostische und chirurgische Herausforderung.

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Literatur

  • Abikhaled JA, Granchi TS, Wall MJ et al (1997) Prolonged abdominal packing for trauma is associated with increased morbidity and mortality. Am Surg 63(12): 1109–1112

    Google Scholar 

  • Al-Nouri O, Hartman B, Fredman R, Thomas C, Esposito T (2012) Diaphragmatic rupture: Is management with biological mesh feasible? Int J Surg Case Rep 3(8): 349–53

    Google Scholar 

  • Atema JJ, Gans SL, Boermeester MA (2014) Systematic Review and Meta-analysis of the Open Abdomen and Temporary Abdominal Closure Techniques in Non-trauma Patients. World J Surg. Dec 2. (Epub ahead of print)

    Google Scholar 

  • Ball CG, Wyrzykowski AD, Nicholas JM, Rozycki GS, Feliciano DV (2011) A decade’s experience with balloon catheter tamponade for the emergency control of hemorrhage. J Trauma 70: 330–333

    Google Scholar 

  • Athanassiadi K, Kalavrouziotis G, Athanassiou M et al (1999) Blunt diaphragmatic rupture. Eur J Cardiothorac Surg 15(4): 469–474

    Google Scholar 

  • Bergeron E, Clas D, Ratte S et al (2002) Impact of deferred treatment of blunt diaphragmatic rupture: a 15-year experience in six trauma centers in Quebec. J Trauma 52(4): 633–640

    Google Scholar 

  • Boele van Hensbroek P, Wind J, Dijkgraaf MG, Busch OR, Goslings JC (2009) Temporary closure of the open abdomen: a systematic review on delayed primary fascial closure in patients with an open abdomen. World J Surg 33(2): 199–207

    Google Scholar 

  • Bowley DM, Barker P, Baffard KD (2006) Intraoperative blood salvage in penetrating abdominal trauma: a randomized, controlled trial. World J Surg 30(6): 1074–1080

    Google Scholar 

  • Brasel KJ, Borgstrom DC, Meyer P, Weigelt JA (1996) Predictors of outcome in blunt diaphragm rupture. J Trauma 41(3): 484–487

    Google Scholar 

  • Bruns H, Frankenberg von M, Radeleff B, Schultze D, Büchler MW, Schemmer P (2009) Chirurgische Therapie des Lebertraumas, Resektion-wann und wie? Chirurg 80: 915–922

    Google Scholar 

  • Cameron JL, Sandone C (2007) Atlas of Gastrointestinal Surgery, Volume 1, pp 374–377

    Google Scholar 

  • Chughtai T, Ali S, Sharkey P, Lins M, Rizoli S (2009) Update on managing diaphragmatic rupture in blunt trauma: a review of 208 consecutive cases. Can J Surg 52(3): 177–181

    Google Scholar 

  • Clarke JM (1989) Case for midline incisions. Lancet 1(8638): 622

    Google Scholar 

  • Committee on Technology for Future Naval Forces (1997) Technology for the United States Navy and Marine Corps, Becoming a 21st-Century Force. 2000-2035. Washington: National Research Council

    Google Scholar 

  • Como JJ, Bokhari F, Chiu WC, Duane TM, Holevar MR, Tandoh MA, Ivatury RR, Scalea TM (2010) Practice management guidelines for selective nonoperative management of penetrating abdominal trauma. J Trauma 68(3): 721–733

    Google Scholar 

  • Cooney R, Ku J, Cherry R et al (2005) Limitations of splenic angioembolization in treating blunt splenic injury. J Trauma 59(4): 926–932

    Google Scholar 

  • Croce MA, Fabian TC, Menke PG, Waddle-Smith L, Minard G, Kudsk KA, Patton JH Jr, Schurr MJ, Pritchard FE (1995) Nonoperative management of blunt hepatic trauma is the treatment of choice for hemodynmically stable patients. Results of a prospective trial. Ann Surg 221(6): 744–753

    Google Scholar 

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

    Google Scholar 

  • Deutsche Gesellschaft für Unfallchirurgie (DGU) (2016) S3-Leitlinie Polytrauma/Schwerverletzten-Behandlung. AWMF-Register-Nr. 012/019, Stand 01.07.2016. AWMF, Düsseldorf. http://www.awmf.org/leitlinien/detail/ll/012-019.html (Zugegriffen 07. Juli 2017)

  • Diener MK, Voss S, Jensen K, Büchler MV, Seiler CM (2010) Elective midline laparotomy closure: the INLINE systematic review and meta-analysis. Ann Surg 251(5): 843–856

    Google Scholar 

  • Diener MK, Knebel P, Kieser M, et al. (2014) Effectiveness of triclosan-coated PDS Plus versus uncoated PDS II sutures for prevention of surgical site infection after abdominal wall closure: the randomised controlled PROUD trial. Lancet 384(9938): 142–152

    Google Scholar 

  • Duchesne JC, Simmons JD, Schmieg RE Jr, McSwain NE Jr, Bellows CF (2008) splenic angioembolization does not improve outcomes in treating blunt splenic injuries compared with splenectomy: a cohort analysis. J Trauma 65(6): 1346–1351

    Google Scholar 

  • Edington HD, Evans S, Sindelar WF (1989) Reconstruction of a functional hemidiaphragm with use of omentum and latissimus dorsi flaps. Surgery 105: 442–445

    Google Scholar 

  • Feliciano DV (1990) Management of traumatic retroperitoneal hematoma. Ann Surg 211: 109

    Google Scholar 

  • Feliciano DV, Mattox KL, Jordan GL Jr (1981) Intra-abdominal packing for control of hepatic hemorrhage: a re-appraisal. J Trauma 21: 285–290

    Google Scholar 

  • Feussner H, Papaziogas W, Siewert JR (1999) Moderne Diagnostik des stumpfen Bauchtraumas Chirurg 70: 1246–1254

    Google Scholar 

  • Gänger KH, Senn A (1987) Die Verletzungen großer Stammvenen. In: Heberer G, van Dongen R.J.A.M (Hrsg) Gefäßchirurgie. Springer-Verlag, Berlin Heidelberg. S 713–715

    Google Scholar 

  • Geks J (2013) Was tun, wenn´s blutet? In: Wagner U, Bartsch D, Hofmann R (Hrsg) Operationsatlas Gynäkologische Onkologie. Spinger-Verlag, Berlin Heidelberg. S 332–335

    Google Scholar 

  • Germanos S, Gourgiotis S, Villias C, Bertucci M, Dimopoulos N, Salemis N (2008) Damage control surgery in the abdomen: An approach for the management of severe injured patients Int J Surg 6(3): 246–252

    Google Scholar 

  • Guillou PJ, Hall TJ, Donaldson DR et al (1980) Vertical abdominal incisions – a choice? Br J Surg 67 (6): 395–399

    Google Scholar 

  • Halsted 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: 1119

    Google Scholar 

  • Harbrecht BG, Ko SH, Watson GA et al (2007) Angiography for blunt splenic trauma does not improve the success rate of nonoperative management. J Trauma 63(1): 44–49

    Google Scholar 

  • Heuer M, Hussmann B, Kaiser G, Nast-Kolb D, Ruchholtz S, Lefering R, Paul A, Taeger G, Lendemans S (2014) Inzidenz von Hohlorganverletzungen nach Trauma: Behandlung, Verlauf und Outcome-eine organspezifische Auswertung von 1127 Patienten des Traumaregisters der DGU. Zentralbl Chir 139: 445–451

    Google Scholar 

  • Hirsch W (2004) Management der bildgebenden Diagnostik. Medizin Forum Aktuell Nr. 325, S 3– 6. Beilage in der Zeitschrift European Journal of Trauma Nr. 3/2004

    Google Scholar 

  • Hirshberg A, Walden R (1997) Damage control for Abdominal Trauma Surg Clin North Am 77:813–820

    Google Scholar 

  • Hodgson NC, Malthaner RA, Ostbye T (2000) The search for an ideal method of abdominal fascial closure: a meta-analysis. Ann Surg. 231(3): 436–442

    Google Scholar 

  • Huang YC, Wu SC, FU CY et al (2012) Tomographic findings are not always predictive of failed nonoperative management in blunt hepatic injury. Am J Surg 203 (4): 448–453

    Google Scholar 

  • Israelsson LA, Millbourn D (2012) Closing midline abdominal incisions. Langenbecks Arch Surg 397(8): 1201–1207

    Google Scholar 

  • Kearney PA, Rihanna SW, Burney RE (1989) Blunt rupture of the diaphragm: mechanism, diagnosis, and treatment. Ann Emerg Med 18(12): 1326–1330

    Google Scholar 

  • Klar E, Angelescu M, Richter G, Herfarth Ch (1999) Aktuelle Therapie bei Verletzungen des hepatobiliopankreatischen Kompartments. Chirurg 70: 1255–1268

    Google Scholar 

  • Kudsk K, Sheldon G (1982) Retroperitoneal trauma. In: Blaisdell F et al (eds) Abdominal trauma. Trauma management. Thieme, Statton New York

    Google Scholar 

  • Li J, Sun SL, Tian JH, Yang K, Liu R, Li J (2015) Cell salvage in emergency trauma surgery. Cochrane Database of Sytematic Reviews, Issue 1. Art. No.: CD007379

    Google Scholar 

  • Letoublon C, Morra I, Chen Y, Monnin V, Voirin D, Arvieux C (2011) Hepatic arterial embolization in the Management of blunt hepatic trauma: indications and complications. J Trauma 70(5): 1032–1036

    Google Scholar 

  • Matthes G, Bauwens K, Ekkernkamp A, Stengel D (2006) Operative Therapie abdomineller Verletzungen Unfallchirurg 109: 437–446

    Google Scholar 

  • Meyers BF, McCabe CJ (1993) Traumatic diaphragmatic hernia. Ocult marker of serious injury. Ann Surg 218(6): 783–790

    Google Scholar 

  • Mihos P, Potaris K, Gakidis J et al (2003) Traumatic rupture of the diaphragm: experience with 65 patients. Injury 34(3): 169–172

    Google Scholar 

  • Mohr AM, Lavery RF, Barone A et al (2003) Angiographic embolization for liver injuries: low mortality, high morbidity. J Trauma 55(6): 1077–1081

    Google Scholar 

  • Monnin V, Sengel C, Thony F et al (2008) Place of arterial embolization in severe blunt hepatic trauma: a multidisciplinary approach. Cardiovasc Intervent Radiol 31(5): 875–882

    Google Scholar 

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

    Google Scholar 

  • Napier JA, Bruce M, Chapman J, Duguid JK, Kelsey PR, Knowles SM et al (1997) Guidelines for autologous transfusion. II. Perioperative haemodilution and cell salvage. British Committee for Standards in Haematology Blood Transfusion Task Force. Autologous Transfusion Working Party. British Journal of Anaesthesia 78(6): 768–771

    Google Scholar 

  • Nast-Kolb D, Trupka A, Ruchholtz S, Schweiberer L (1998) Abdominaltrauma Unfallchirurg 101: 82–91

    Google Scholar 

  • Nelson R, Singer M (2002) Primary repair for penetrating colon injuries. Cochrane Database Syst Rev 3: CD002247

    Google Scholar 

  • Oniscu GC, Parks RW, Garden OJ (2006) Classification of liver and pancreatic trauma. HPB (Oxford) 8(1): 4–9

    Google Scholar 

  • Peitzman AB, Heil B, Rivera L et al (2000) Blunt splenic injury in adults: Multi-institutional Study of Eastern Association for the Surgery of Trauma. J Trauma 49: 177

    Google Scholar 

  • Pieracci FM, Jurkovich GJ (2014) Penetrating Abdominal Trauma, In: Cameron JL, Cameron AM (eds) Current Surgical Therapy, 11th Edition, Elsevier, Saunders pp 1021–1027

    Google Scholar 

  • Pringle JH (1908). Notes on the Arrest of Hepatic Hemorrhage Due to Trauma. Ann Surg 48(4): 541–549

    Google Scholar 

  • Quyn AJ, Johnston C, Hall D et al (2012) The open abdomen and temporary abdominal closure systems-historical evolution and systematic review. Colorectal Dis 14(8): e429–e438

    Google Scholar 

  • Rauchfuß F, Voigt R, Götz M, Heise M, Überrück T, Settmacher U (2009) Damage-control-Konzept bei Leberverletzungen, Package-Strategien und sekundäre Maßnahmen. Chirurg 80:923–928

    Google Scholar 

  • Regner JL, Kobayashi L, Coimbra R (2012) Surgical Strategies for Management of the Open Abdomen. World J Surg 36: 497–510

    Google Scholar 

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

    Google Scholar 

  • Rotondo MF, Schwab CW, McGonigal MD et al (1993) «Damage control»: An approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma 35: 375–383

    Google Scholar 

  • Sagraves SG, Toschlog EA, Rotondo MF (2006) Damage control surgery- the intensivist’s role. J Intensive Care Med 21: 5–16

    Google Scholar 

  • Sauerland S, Agresta F, Bergamaschi R et al (2006) Laparoscopy for abdominal emergencies: an evidence-based guideline of the European Association for Endoscopic Surgery. Surg Endosc 20(1): 14–29

    Google Scholar 

  • Schmelzle M, Alldinger I, Matthaei H, Aydin F, Wallert I, Eisenberger CF, Schulte am Esch J, Dizdar L, Topp SA, Yang Q, Knoefel WT (2010) Long-Term Vacuum-Assisted Closure in Open Abdomen due to Secondary Peritonitis: A Retrospective Evaluation of a Selected Group of Patients. Dig Surg 27: 272–278

    Google Scholar 

  • Schroeder WE (1906) The process of liver hemostasis: reports of cases. Surg Gyn Obs 2: 52

    Google Scholar 

  • Schumpelick V, Ambacher T, Riesener KP (1999) Aktuelle Therapie der Verletzungen von Colon und Retroperitoneum. Chirurg 70: 1269–1277

    Google Scholar 

  • Shah R, Sabanathan S, Mearns AJ, Choudhury AK (1995) Traumatic rupture of diaphragm. Ann Thorac Surg 60(5): 1444–1449

    Google Scholar 

  • Smith HE, Biffl WL, Majercik SD et al (2006) Splenic artery embolization: Have we gone too far? J Trauma 61(3): 541–544

    Google Scholar 

  • Ständige Impfkommission (STIKO) (2016) Impfungen bei Asplenie, Stand Oktober 2016. http://www.rki.de/SharedDocs/FAQ/Impfen/AllgFr_Grunderkrankungen/FAQ-Liste_Impfen_und_Grunderkrankungen.html#FAQId2407556 (Zugegriffen 07. Juli 2017)

  • Stone HH, Strom PR, Mullins RJ (1983) Management of the major coagulopathy with onset during laparotomy. Ann Surg 197: 532–535

    Google Scholar 

  • Tsuei BJ, Skinner JC, Bernard AC, Kearney PA, Boulanger BR (2004) The open peritoneal cavity: etiology correlates with the likelihood of fascial closure. Am Surg 70(7): 652–656

    Google Scholar 

  • Tugnoli G, Bianchi E, Biscardi A, Coniglio C, Isceri S, Simonetti L, Gordini G, Di Saverio S (2015) Nonoperative management of blunt splenic injury in adults: there is (still) a long way to go. The results of the Bologna-Maggiore Hospital trauma center experience and development of a clinical algorithm. Surg Today 45(10): 1210–1217

    Google Scholar 

  • Vanderlinde ES, Heal JM, Blumberg N (2002) Autologous transfusion. BMJ 324(7340): 772–775

    Google Scholar 

  • vanʼt Riet M, Steyerberg EW, Nellensteyn J, Bonjer HJ, Jeekel J (2002) Meta-analysis of techniques for closure of midline abdominal incisions. Br J Surg 89(11): 1350–1356

    Google Scholar 

  • Velanovich V (1995) Blunt splenic injury in adults: a decision analysis comparing options for treatment. Eur J Surg 161(7): 46–470

    Google Scholar 

  • Wahl WL, Ahrns KS, Brandt MM, Franklin GA, Taheri PA (2002) The need for early angiographic embolization in blunt liver injuries. J Trauma 52(6): 1097–1101

    Google Scholar 

  • Watts DD, Fakhry SM (2003) Incidence of Hollow Viscus Injury in Blunt Trauma: An Analysis from 275,557 Trauma Admissions from the East Multi-Institutional Trial. J Trauma 54: 289–294

    Google Scholar 

  • Wit J (2004) Grenzen der konservativen Therapie. Medizin Forum Aktuell Nr. 325, S 7–8. Beilage in der Zeitschrift European Journal of Trauma Nr. 3/2004

    Google Scholar 

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Authors and Affiliations

  1. Allgemeine, Viszerale und Onkologische Chirurgie, Klinikum Wetzlar, Forsthausstraße 1, 35578, Wetzlar, Deutschland

    Dr. med. C. Wurster

  2. Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Marburg, Baldingerstraße, 35043, Marburg, Deutschland

    Prof. Dr. med. D. K. Bartsch

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  1. Dr. med. C. Wurster
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Correspondence to C. Wurster or D. K. Bartsch .

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  1. Universitätsspital Zürich, Zürich, Switzerland

    Hans-Christoph Pape

  2. Klinik für Unfall- und Wiederherstellung, Universitätsklinikum RWTH Aachen, Aachen, Deutschland

    Frank Hildebrand

  3. Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Marburg, Marburg, Deutschland

    Steffen Ruchholtz

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Wurster, C., Bartsch, D.K. (2018). Stammverletzung: Abdomen. In: Pape, HC., Hildebrand, F., Ruchholtz, S. (eds) Management des Schwerverletzten. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-54980-3_15

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