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Abdominal War Wounds—Experiences from Red Cross Field Hospitals

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.

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References

  1. D Dufour S Kroman Jensen M Owen-Smith et al. (1988) Surgery for Victims of War International Committee of the Red Cross Geneva

    Google Scholar 

  2. R Coupland (1996) ArticleTitleAbdominal wounds in war Br. J. Surg 83 1505–1511 Occurrence Handle1:STN:280:ByiC28npslc%3D Occurrence Handle9014662

    CAS  PubMed  Google Scholar 

  3. A Leppäniemi (1998) ArticleTitleMedical challenges of internal conflicts World J. Surg 22 1197–1201 Occurrence Handle9841743

    PubMed  Google Scholar 

  4. JM Ryan GJ Cooper IR Haywood et al. (1991) ArticleTitleField surgery on a future conventional battlefield: strategy and wound management Ann. R. Coll. Surg. Engl 73 13–20 Occurrence Handle1:STN:280:By6C2cvit10%3D

    CAS  Google Scholar 

  5. RF Bellamy (1984) ArticleTitleThe causes of death in conventional land warfare: implications for combat casualty care research Milit. Med 149 55–62 Occurrence Handle1:STN:280:BiuB38%2FhvV0%3D

    CAS  Google Scholar 

  6. NM Rich (1968) ArticleTitleVietnam missile wounds evaluated in 750 patients Milit. Med 133 9–22 Occurrence Handle1:STN:280:CCeC3sritlA%3D

    CAS  Google Scholar 

  7. JM Feltis SuffixJr. (1970) ArticleTitleSurgical experience in a combat zone. Am J Surg 119 275–278

    Google Scholar 

  8. WG Byerly PD Pendse (1971) ArticleTitleWar surgery in a forward surgical hospital in Vietnam: a continuing report Milit. Med 136 221–226 Occurrence Handle1:STN:280:CSyD3snnsVc%3D

    CAS  Google Scholar 

  9. DS Jackson CG Batty JM Ryan et al. (1983) ArticleTitleThe Falklands war: army field surgical experience Ann. R. Coll. Surg. Engl 65 281–285 Occurrence Handle1:STN:280:BiyA3cjgtFY%3D Occurrence Handle6614760

    CAS  PubMed  Google Scholar 

  10. TJW Spalding MPM Stewart DN Tulloch et al. (1991) ArticleTitlePenetrating missile injuries in the Gulf War 1991 Br. J. Surg 78 1102–1104 Occurrence Handle1:STN:280:By2D3sznsFE%3D Occurrence Handle1933196

    CAS  PubMed  Google Scholar 

  11. A Trouwborst BK Weber D Dufour (1987) ArticleTitleMedical statistics of battlefield casualties Injury 18 96–99 Occurrence Handle1:STN:280:BiaB3M3os1c%3D Occurrence Handle3508167

    CAS  PubMed  Google Scholar 

  12. J Rautio P Paavolainen (1988) ArticleTitleAfghan war wounded: experience with 200 cases J. Trauma 28 523–525 Occurrence Handle1:STN:280:BieC2s3mtFw%3D Occurrence Handle3280819

    CAS  PubMed  Google Scholar 

  13. GW Bowyer (1995) ArticleTitleAfghan war wounded: application of the Red Cross wound classification J. Trauma 38 64–67 Occurrence Handle1:STN:280:ByqB28vktVY%3D Occurrence Handle7745662

    CAS  PubMed  Google Scholar 

  14. RM Hardaway ParticleIII (1978) ArticleTitleViet Nam wound analysis J. Trauma 18 635–643 Occurrence Handle731752

    PubMed  Google Scholar 

  15. MJ VanRooyen EP Sloan AE Radvany et al. (1995) ArticleTitleThe incidence and outcome of penetrating and blunt trauma in central Bosnia: the Nova Bila hospital for war wounded J. Trauma 38 863–866 Occurrence Handle1:STN:280:ByqA38nhvVY%3D Occurrence Handle7602624

    CAS  PubMed  Google Scholar 

  16. RR Rozin Y Kleinman (1987) ArticleTitleSurgical priorities of abdominal wounded in a combat situation J. Trauma 27 656–660 Occurrence Handle1:STN:280:BiiB2MvivFc%3D Occurrence Handle3599112

    CAS  PubMed  Google Scholar 

  17. Z Nassoura H Hajj O Dajani et al. (1991) ArticleTitleTrauma management in a war zone: the Lebanese war experience J. Trauma 31 1596–1599 Occurrence Handle1:STN:280:By2D1crjt1M%3D Occurrence Handle1749028

    CAS  PubMed  Google Scholar 

  18. RM Coupland (1994) ArticleTitleEpidemiological approach to surgical management of the casualties of war BMJ 308 1693–1697 Occurrence Handle1:STN:280:ByuB1MjksFw%3D Occurrence Handle8025468

    CAS  PubMed  Google Scholar 

  19. DS Morris WJ Sugrue (1991) ArticleTitleAbdominal injuries in the war wounded of Afghanistan: a report from the International Committee of the Red Cross hospital in Kabul Br. J. Surg 78 1301–1304 Occurrence Handle1:STN:280:By2C3czksVA%3D Occurrence Handle1760686

    CAS  PubMed  Google Scholar 

  20. CM Wind ParticleDe (1987) ArticleTitleWar injuries treated under primitive circumstances: experiences in an Ugandan mission hospital Ann. R. Coll. Surg. Engl. 69 193–195 Occurrence Handle3674679

    PubMed  Google Scholar 

  21. B Eshaya-Chauvin R Coupland (1992) ArticleTitleTransfusion requirements for the management of war injured: the experience of the International Committee of the Red Cross Br. J. Anaesth 68 221–223 Occurrence Handle1:STN:280:By2C2s3msFQ%3D Occurrence Handle1540469

    CAS  PubMed  Google Scholar 

  22. A Hirshberg KL Mattox (1993) ArticleTitle“Damage control” in trauma surgery Br. J. Surg 80 1501–1502 Occurrence Handle1:STN:280:ByuC3s%2FgtlY%3D Occurrence Handle8298911

    CAS  PubMed  Google Scholar 

  23. RY Calne P McMaster BD Pentlow (1979) ArticleTitleThe treatment of major liver trauma by primary packing with transfer of the patients for definitive treatment Br. J. Surg 66 338–339 Occurrence Handle1:STN:280:CSaC1cflsFA%3D Occurrence Handle444853

    CAS  PubMed  Google Scholar 

  24. DV Feliciano KL Mattox GL Jordan SuffixJr. (1981) ArticleTitleIntra-abdominal packing for control of hepatic hemorrhage: a reappraisal J. Trauma 21 285–290 Occurrence Handle1:STN:280:Bi6C2s%2FmsV0%3D Occurrence Handle7012380

    CAS  PubMed  Google Scholar 

  25. MF Rotondo CW Schwab MD McGonigal et al. (1993) ArticleTitle“Damage control”: an approach for improved survival in exsanguinating penetrating abdominal injury J. Trauma 35 375–383 Occurrence Handle1:STN:280:ByyA1c7nt1c%3D Occurrence Handle8371295

    CAS  PubMed  Google Scholar 

  26. B Eiseman (1967) ArticleTitleCombat casualty management in Vietnam J. Trauma 7 53–63 Occurrence Handle1:STN:280:CCiD1M7hvFU%3D Occurrence Handle6018132

    CAS  PubMed  Google Scholar 

  27. D Morris W Sugrue (1985) ArticleTitleOn the border of Afghanistan with the International Committee of the Red Cross N.Z. Med. J. 98 750–752 Occurrence Handle1:STN:280:BimD3Mris1I%3D Occurrence Handle3863054

    CAS  PubMed  Google Scholar 

  28. BA Georgi M Massad M Obeid (1991) ArticleTitleBallistic trauma to the abdomen: shell fragments versus bullets J. Trauma 31 711–716 Occurrence Handle1:STN:280:By6B3s3htlw%3D Occurrence Handle2030519

    CAS  PubMed  Google Scholar 

  29. LC Getzen SB Bellinger RD Simmons et al. (1972) ArticleTitleA critical review of 83 penetrating abdominal visceral injuries Milit. Med 137 173–180 Occurrence Handle1:STN:280:CS2C1c%2Fnt1I%3D

    CAS  Google Scholar 

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Correspondence to Ari K. Leppäniemi M.D..

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Leppäniemi, A.K. Abdominal War Wounds—Experiences from Red Cross Field Hospitals. World J. Surg. 29, S67–S71 (2005). https://doi.org/10.1007/s00268-004-2065-z

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Keywords

  • Abdominal Injury
  • Intestinal Perforation
  • Small Bowel Injury
  • Bullet Wound
  • Coagulation Factor Deficiency