World Journal of Surgery

, Volume 29, Supplement 1, pp S67–S71 | Cite as

Abdominal War Wounds—Experiences from Red Cross Field Hospitals

Article

Abstract

The traditional approach to abdominal war wounds consists of triage, eche-loned care, and mandatory laparotomy for penetrating abdominal injuries, and it remains valid in modern conventional wars with well-organized evacuation and surgical services. Expectant management of abdominal casualties can be considered under difficult circumstances with a high influx of patients exhausting the available resources. This can occur in regional conflicts associated with mass movements of people and with collapsed infrastructure. While always combined with adequate fluid resuscitation, antibiotic treatment, and other supportive care, the expectant approach in patients with penetrating abdominal injuries could be indicated for asymptomatic patients with multiple fragment wounds or for patients presenting several days post-injury in good condition. The focus of surgical resources and competence should be on the majority of patients with intestinal perforation only, who need surgery to save life—but not necessarily on an urgent basis—and who have a good chance of survival. The limited availability of blood products to correct blood loss and coagulation factor deficiencies, and the lack of sophisticated monitoring of hemodynamic variables that call into question the value of a damage-control approach for the most severely injured. Even if the bleeding could be temporarily controlled, the subsequent need for adequate resuscitation before returning the patient to the operating room could be difficult to achieve and would result in incompletely resuscitated patients being reoperated while acidotic, coagulopathic, and even hypothermic. Perhaps, in mass casualty situations these patients should be recognized during triage or at least early during operation, and aggressive surgery should be replaced with adequate expectant management with sedation and analgesics.

References

  1. 1.
    Dufour, D, Kroman Jensen, S, Owen-Smith, M,  et al. 1988Surgery for Victims of WarInternational Committee of the Red CrossGenevaGoogle Scholar
  2. 2.
    Coupland, R 1996Abdominal wounds in warBr. J. Surg8315051511PubMedGoogle Scholar
  3. 3.
    Leppäniemi, A 1998Medical challenges of internal conflictsWorld J. Surg2211971201PubMedGoogle Scholar
  4. 4.
    Ryan, JM, Cooper, GJ, Haywood, IR,  et al. 1991Field surgery on a future conventional battlefield: strategy and wound managementAnn. R. Coll. Surg. Engl731320Google Scholar
  5. 5.
    Bellamy, RF 1984The causes of death in conventional land warfare: implications for combat casualty care researchMilit. Med1495562Google Scholar
  6. 6.
    Rich, NM 1968Vietnam missile wounds evaluated in 750 patientsMilit. Med133922Google Scholar
  7. 7.
    Feltis, JM,Jr. 1970Surgical experience in a combat zone. AmJ Surg119275278Google Scholar
  8. 8.
    Byerly, WG, Pendse, PD 1971War surgery in a forward surgical hospital in Vietnam: a continuing reportMilit. Med136221226Google Scholar
  9. 9.
    Jackson, DS, Batty, CG, Ryan, JM,  et al. 1983The Falklands war: army field surgical experienceAnn. R. Coll. Surg. Engl65281285PubMedGoogle Scholar
  10. 10.
    Spalding, TJW, Stewart, MPM, Tulloch, DN,  et al. 1991Penetrating missile injuries in the Gulf War 1991Br. J. Surg7811021104PubMedGoogle Scholar
  11. 11.
    Trouwborst, A, Weber, BK, Dufour, D 1987Medical statistics of battlefield casualtiesInjury189699PubMedGoogle Scholar
  12. 12.
    Rautio, J, Paavolainen, P 1988Afghan war wounded: experience with 200 casesJ. Trauma28523525PubMedGoogle Scholar
  13. 13.
    Bowyer, GW 1995Afghan war wounded: application of the Red Cross wound classificationJ. Trauma386467PubMedGoogle Scholar
  14. 14.
    Hardaway, RM 1978Viet Nam wound analysisJ. Trauma18635643PubMedGoogle Scholar
  15. 15.
    VanRooyen, MJ, Sloan, EP, Radvany, AE,  et al. 1995The incidence and outcome of penetrating and blunt trauma in central Bosnia: the Nova Bila hospital for war woundedJ. Trauma38863866PubMedGoogle Scholar
  16. 16.
    Rozin, RR, Kleinman, Y 1987Surgical priorities of abdominal wounded in a combat situationJ. Trauma27656660PubMedGoogle Scholar
  17. 17.
    Nassoura, Z, Hajj, H, Dajani, O,  et al. 1991Trauma management in a war zone: the Lebanese war experienceJ. Trauma3115961599PubMedGoogle Scholar
  18. 18.
    Coupland, RM 1994Epidemiological approach to surgical management of the casualties of warBMJ30816931697PubMedGoogle Scholar
  19. 19.
    Morris, DS, Sugrue, WJ 1991Abdominal injuries in the war wounded of Afghanistan: a report from the International Committee of the Red Cross hospital in KabulBr. J. Surg7813011304PubMedGoogle Scholar
  20. 20.
    Wind, CM 1987War injuries treated under primitive circumstances: experiences in an Ugandan mission hospitalAnn. R. Coll. Surg. Engl.69193195PubMedGoogle Scholar
  21. 21.
    Eshaya-Chauvin, B, Coupland, R 1992Transfusion requirements for the management of war injured: the experience of the International Committee of the Red CrossBr. J. Anaesth68221223PubMedGoogle Scholar
  22. 22.
    Hirshberg, A, Mattox, KL 1993“Damage control” in trauma surgeryBr. J. Surg8015011502PubMedGoogle Scholar
  23. 23.
    Calne, RY, McMaster, P, Pentlow, BD 1979The treatment of major liver trauma by primary packing with transfer of the patients for definitive treatmentBr. J. Surg66338339PubMedGoogle Scholar
  24. 24.
    Feliciano, DV, Mattox, KL, Jordan, GL,Jr. 1981Intra-abdominal packing for control of hepatic hemorrhage: a reappraisalJ. Trauma21285290PubMedGoogle Scholar
  25. 25.
    Rotondo, MF, Schwab, CW, McGonigal, MD,  et al. 1993“Damage control”: an approach for improved survival in exsanguinating penetrating abdominal injuryJ. Trauma35375383PubMedGoogle Scholar
  26. 26.
    Eiseman, B 1967Combat casualty management in VietnamJ. Trauma75363PubMedGoogle Scholar
  27. 27.
    Morris, D, Sugrue, W 1985On the border of Afghanistan with the International Committee of the Red CrossN.Z. Med. J.98750752PubMedGoogle Scholar
  28. 28.
    Georgi, BA, Massad, M, Obeid, M 1991Ballistic trauma to the abdomen: shell fragments versus bulletsJ. Trauma31711716PubMedGoogle Scholar
  29. 29.
    Getzen, LC, Bellinger, SB, Simmons, RD,  et al. 1972A critical review of 83 penetrating abdominal visceral injuriesMilit. Med137173180Google Scholar

Copyright information

© Société Internationale de Chirurgie 2005

Authors and Affiliations

  1. 1.Department of SurgeryMeilahti Hospital, University of HelsinkiHelsinkiFinland

Personalised recommendations