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Konservative vs. chirurgische Therapie des Bauchtraumas

Wie viel Chirurgie benötigt das Bauchtrauma?

Conservative versus surgical therapy of pediatric blunt abdominal trauma

How much surgery is needed for abdominal trauma?

  • Notfälle im Kindes- und Jugendalter
  • Published:
Monatsschrift Kinderheilkunde Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Unfälle stellen bei Kindern statistisch die häufigste Todesursache dar; hierbei trägt das stumpfe Bauchtrauma wesentlich zu Morbidität und Mortalität bei. Innerhalb der letzten Jahrzehnte ist es bezüglich der Therapie zu einem Paradigmenwandel gekommen. Verletzungen der parenchymatösen Organe können beim kreislaufstabilen Kind meist konservativ behandelt werden.

Fragestellung

Wie viel Chirurgie benötigt das stumpfe Bauchtrauma beim Kind, und inwiefern ist ein frühes Hinzuziehen des Kinderchirurgen notwendig?

Material und Methoden

Der Beitrag fasst die aktuelle internationale Literatur zusammen.

Ergebnisse

Die Mehrzahl aller Kinder mit stumpfem Bauchtrauma kann konservativ therapiert werden. Wenn jedoch eine chirurgische Intervention erforderlich ist, besteht häufig eine vitale Indikation, die ohne Zeitverzögerung durchgeführt werden muss.

Schlussfolgerung

Das verletzte Kind benötigt ein spezialisiertes pädiatrisches Traumateam, das sowohl die Diagnostik als auch die Therapie interdisziplinär plant und durchführt. Jedes unfallverletzte Kind mit Verdacht auf ein stumpfes Bauchtrauma sollte notwendigerweise in ein Kinderzentrum eingewiesen werden. Hier können Ersteinschätzung, Diagnostik und Indikationsstellung gemeinsam mit einem Kinderchirurgen erfolgen.

Abstract

Background

Accidents are the leading cause of death in children and blunt abdominal trauma significantly contributes to the morbidity and mortality. Over the last decades a paradigm shift has occurred in therapy. Solid organ injuries can mostly be treated nonoperatively if the child is hemodynamically stable.

Objective

How much surgery is necessary for blunt abdominal trauma in children? How early do pediatric surgeons need to be involved?

Material and methods

The article reviews the current international literature.

Results

Most children with blunt abdominal trauma can be nonoperatively treated. If a surgical intervention is necessary, the indications are often vital and surgery needs to be carried out without any time delay.

Conclusion

The injured child needs a specialized interdisciplinary pediatric trauma team which plans the diagnostic and therapeutic steps together. Every child with suspected blunt abdominal trauma needs to be transferred to a designated pediatric trauma center where the primary assessment and decision making are carried out together with a pediatric surgeon.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. S. Zundel und P. Szavay geben an, dass kein Interessenkonflikt besteht.

Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, bzw. die Erziehungsberechtigten haben hierzu ihre schriftliche Einwilligung gegeben. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Kinderchirurgische Klinik, Luzerner Kantonsspital, Luzern 16, 6000, Luzern, Schweiz

    S. Zundel & P. Szavay

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Correspondence to S. Zundel.

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Zundel, S., Szavay, P. Konservative vs. chirurgische Therapie des Bauchtraumas. Monatsschr Kinderheilkd 163, 1167–1172 (2015). https://doi.org/10.1007/s00112-015-3472-y

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