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Vorgehen bei traumatischen Darmverletzungen bei MANV

Management of traumatic intestinal injury of mass casualties

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Zusammenfassung

Während es beim stumpfen Bauchtrauma nur selten zu Darmverletzungen kommt, sind Darmverletzungen bei penetrierenden Verletzungen, insbesondere bei Explosionstraumen die typische Verletzungsfolge. Unabhängig von einem möglicherweise negativen computertomographischen Befund sollte bei penetrierenden Abdominalverletzungen großzügig die Indikation zur chirurgischen Exploration gestellt werden. In einer Triagesituation sollten zunächst hämodynamisch instabile Patienten und Patienten mit abdomineller Abwehrspannung und/oder Peritonismus exploriert werden. Neben akuten intraabdominellen Blutungen besteht vor allem die Gefahr späterer septischer Komplikationen bei nichterkannten Hohlorganperforationen. Das individuelle Vorgehen richtet sich nach der Gesamtlage und den individuellen Begleitverletzungen. Beim Vorliegen von Damage-control-surgery(DCS)-Kriterien sollten nur lebensrettende operative Sofortmaßnahmen durchgeführt und ein Laparostoma angelegt werden. Rekonstruktionen am Darm und eine Stomaanlage können dann im Intervall erfolgen.

Abstract

While intestinal injury is relatively rare in blunt abdominal trauma, it is common in penetrating abdominal trauma. Intestinal injury cannot be detected effectively by computed tomography (CT); therefore penetrating abdominal injury or abdominal signs in blunt trauma require liberal indications for explorative laparotomy. In mass casualty situations patients with hemodynamic instability and abdominal signs should be prioritized for surgery. Besides intra-abdominal hemorrhage the major issue is septic complications due to intestinal perforation. The current surgical strategy should reflect the number of injured patients and the individual pattern of injuries. Damage control surgery is not an effective strategy to improve survival rates in severely injured patients or in mass casualty situations. Damage control surgery focuses on lifesaving procedures especially bleeding control and control of contamination. This includes an open abdomen strategy with later definitive repair and abdominal wall closure

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Authors and Affiliations

  1. Klinik & Poliklinik für Allgemein- und Viszeralchirurgie, Gefäß- und Kinderchirurgie, Universitätsklinik Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland

    J. F. Lock, F. Anger & C.-T. Germer

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  1. J. F. Lock
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  2. F. Anger
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  3. C.-T. Germer
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Correspondence to J. F. Lock.

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Interessenkonflikt

J.F. Lock, F. Anger und C.-T. Germer geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Lock, J.F., Anger, F. & Germer, CT. Vorgehen bei traumatischen Darmverletzungen bei MANV. Chirurg 88, 848–855 (2017). https://doi.org/10.1007/s00104-017-0492-2

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  • DOI: https://doi.org/10.1007/s00104-017-0492-2

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