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. 2020 Nov;91(11):979-988.
doi: 10.1007/s00104-020-01272-x.

[Penetrating abdominal trauma]

[Article in German]
Svenja Sliwinski  1 , Wolf O Bechstein  2 , Andreas A Schnitzbauer  2 , Pa Tri Zia Malkomes  2
Affiliations

[Penetrating abdominal trauma]

[Article in German]
Svenja Sliwinski et al. Chirurg. 2020 Nov.

Abstract
in English, German

The management of patients with penetrating abdominal trauma has significantly changed in recent years. While exploratory laparotomy was the gold standard in Germany in all patients up to the 1970s, selective nonoperative management (SNOM) is increasingly being discussed in hemodynamically stable patients without pathological findings in computed tomography (CT) scan or extended focussed assessment with sonography for trauma (eFAST). A standard algorithm taking a balance between invasiveness, patient safety and the use of resources into account has still to be implemented in Germany. The presented algorithm includes an immediate laparotomy in hemodynamically unstable patients as damage control surgery followed by a second look procedure after 48 h. Hemodynamically stable patients should primarily undergo diagnostic laparoscopy and be treated by early total care surgery, depending on the clinical and diagnostic imaging findings. Patients without clinical symptoms or pathological findings in imaging studies should be treated according to SNOM with close clinical controls.

Das Management des penetrierenden Abdominaltraumas unterliegt in den letzten Jahren einem deutlichen Wandel. Während die explorative Laparotomie bei allen Patienten bis in die 1970er-Jahre der Goldstandard in Deutschland war, wird zunehmend ein selektives nichtoperatives Management (SNOM) bei hämodynamisch stabilen Patienten ohne pathologischen Befund in CT oder eFAST diskutiert. Ein Standardalgorithmus, welcher eine Balance zwischen Invasivität, Patientensicherheit und Ressourcennutzung schafft, besteht aktuell in Deutschland nicht. Der vorgestellte Algorithmus umfasst eine sofortige Laparotomie bei instabilen Patienten als „damage control surgery“ mit Second Look nach 48 h. Hämodynamisch stabile Patienten sollten je nach klinischen und bildmorphologischen Befunden primär diagnostisch laparoskopiert werden. „Early total care“ dient dabei der Versorgung begrenzter und direkt therapierbarer Verletzungen. Bei fehlender Klinik und unauffälliger Bildgebung sollten die Patienten nach dem Prinzip von SNOM mit engmaschigen klinischen Kontrollen behandelt werden.

Keywords: Damage control surgery; Diagnostic laparoscopy; Injury pattern; Selective nonoperative management; Treatment algorithm.

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References

Literatur

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