1. [Management of Injuries to the Parenchymal Abdominal Organs].
- Author
-
Schild-Suhren S, Yilmaz E, Biggemann L, Seif A, Torsello GF, Uhlig A, Ghadimi M, and Bösch F
- Subjects
- Humans, Wounds, Nonpenetrating surgery, Wounds, Nonpenetrating diagnostic imaging, Wounds, Nonpenetrating therapy, Wounds, Nonpenetrating diagnosis, Spleen injuries, Spleen diagnostic imaging, Tomography, X-Ray Computed, Multiple Trauma surgery, Multiple Trauma diagnostic imaging, Multiple Trauma diagnosis, Laparotomy, Kidney injuries, Kidney diagnostic imaging, Abdominal Injuries surgery, Abdominal Injuries diagnostic imaging, Abdominal Injuries therapy, Abdominal Injuries diagnosis, Liver injuries, Liver diagnostic imaging, Liver surgery, Pancreas injuries, Pancreas surgery, Pancreas diagnostic imaging
- Abstract
The most common organs affected by abdominal trauma are the spleen and the liver, often in combination. Pancreatic injuries are rare. In the case of blunt abdominal trauma, which is much more common, a clinical and laboratory examination as well as sonography should be performed. In the initial assessment, the circulatory situation must be screened. If there is haemodynamic instability and presentation of free fluid, an emergency laparotomy is indicated. If the situation is stable or stabilised and a pathological sonography is present, it is essential to perform triphasic contrast enhanced computed tomography, which is also mandatory in polytraumatised patients. If a renal injury is suspected, a late venous phase should be attached. In addition to the classification of the injury, attention should be paid to possible vascular injury or active bleeding. In this case, angiography with the possibility of intervention should be performed. Endoscopic treatment is possible for injuries of the pancreatic duct. If the imaging does not reveal any intervention target and a circulation is stable, a conservative approach is possible with continuous monitoring using clinical, laboratory and sonographic controls. Most injuries can be successfully treated by non-operative management (NOM).There are various surgical options for treating the injury, such as local and resecting procedures. There is also the option of "damage control surgery" with acute bleeding control and second look. Complex surgical procedures should be performed at centres. Postoperative complications arise out of elective surgery.In the less common case of penetrating abdominal trauma, the actual extent of the injury cannot be estimated from the visible wound. Here again, the circulatory situation determines the next steps. An emergency laparotomy should be carried out in case of instability. If the condition is stable, further diagnostics should be performed using contrast enhanced computed tomography. If penetration through the peritoneum cannot be clearly excluded, diagnostic laparoscopy should be performed., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF