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Operative Therapie abdomineller Verletzungen

Surgical management of abdominal injury

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Zusammenfassung

Ziel

Begleitende Verletzungen des Abdomens sind beim Polytrauma typisch und stellen eine der häufigsten Todesursachen dar. Ziel der vorliegenden Arbeit war eine Literaturanalyse mit Darstellung wesentlicher Aspekte der initialen operativen Versorgung abdomineller Verletzungsfolgen.

Methode

Die Literaturrecherche erfolgte in PubMed Medline, dem Cochrane Central Register of Controlled Clinical Trials und den Datenbanken der DIMDI. Die Graduierung der Beweiskraft der zugrundeliegenden Studien erfolgte nach den Vorschlägen des Centre for Evidence-based Medicine.

Ergebnisse

Bei der Versorgung abdomineller Verletzungen sollte die Medianlaparatomie bevorzugt werden. Insbesondere beim instabilen Patienten ist eine Versorgung nach Damage-Control-Prinzipien anzustreben. Bei Verletzungen des Kolons sollte, wenn es der Gesamtzustand des Patienten zulässt, eine primäre Anastomose realisiert werden. Hier ist die Handnaht am besten geeignet. Bei Milzverletzungen ist ein Organerhalt vorzusehen. Eine angiographische Embolisation blutender Läsionen von Leber und Milz sollte frühzeitig erwogen werden.

Diskussion

Die konservative Therapie stumpfer Abdominalverletzungen tritt zunehmend in den Vordergrund. Ist eine operative Intervention unumgänglich, sollte gerade beim instabilen Patienten zugunsten der Damage-Control-Prinzipien entschieden werden.

Abstract

Purpose

Accompanying abdominal injuries are frequent in multiply injured patients and are a common cause of death. A search of the literature was performed focusing on key aspects of initial surgical procedures in abdominal injury.

Methods

Literature was searched utilizing PubMed Medline, the Cochrane Central Register of Controlled Clinical Trials, and the German Institute for Medical Documentation and Information (DIMDI) database. The articles were classified according to the level of evidence following the suggestions of the Centre for Evidence Based Medicine.

Results

Vertical laparotomy should be favored for the initial surgical therapy of abdominal injury. Especially in instable patients, principles of “damage control surgery” should be applied. In case of hollow organ injury, a primary anastomosis should be made whenever possible. A hand suture is most suitable for this.

Discussion

Non-surgical treatment of blunt abdominal injury is gaining in importance. However, if a surgical intervention is recommended, especially in hemodynamic, instable patients, damage control principles should be favored.

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Authors and Affiliations

  1. Ernst-Moritz-Arndt-Universität Greifswald, Unfall- und Wiederherstellungschirurgie, Sauerbruchstraße, 17475, Greifswald

    G. Matthes, A. Ekkernkamp & D. Stengel

  2. Unfallkrankenhaus Berlin, Klinik für Unfall- und Wiederherstellungschirurgie

    G. Matthes, K. Bauwens, A. Ekkernkamp & D. Stengel

  3. Unfallkrankenhaus Berlin, Zentrum für Klinische Forschung

    K. Bauwens, A. Ekkernkamp & D. Stengel

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  1. G. Matthes
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  2. K. Bauwens
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  4. D. Stengel
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Correspondence to G. Matthes.

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Matthes, G., Bauwens, K., Ekkernkamp, A. et al. Operative Therapie abdomineller Verletzungen. Unfallchirurg 109, 437–446 (2006). https://doi.org/10.1007/s00113-006-1065-x

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