Abdominal War Wounds–Experiences from Red Cross Field Hospitals

Leppäniemi, Ari K.
June 2005
World Journal of Surgery;Jun2005 Supplement 1, Vol. 29, pS67
Academic Journal
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.


Related Articles

  • Ballistic Thoracoabdominal Injury: Analysis of Recent Military Experience in Afghanistan. Morrison, J. J.; Midwinter, M. J.; Jansen, J. O. // World Journal of Surgery;Jun2011, Vol. 35 Issue 6, p1396 

    Background: Military surgery has seen the arrival of the critical care provision and cross-sectional imaging enjoyed by civilian trauma surgeons. Ballistic injury to the thoracoabdominal region is uncommon but potentially devastating. The aim of this study was to analyze recent military...

  • Occult abdominal injury.  // British Medical Journal;5/22/1976, Vol. 1 Issue 6020, p1236 

    Examines the occult abdominal injury. Rate of mortality; Reasons for the delay in the diagnosis of occult abdominal injuries; Types of clinical presentation for the delay in the diagnosis.

  • ABDOMINAL TRAUMA. cope, Andrew; Stebbings, William // BMJ: British Medical Journal (International Edition);7/21/90, Vol. 301 Issue 6744, p172 

    Assesses the management of patients with abdominal trauma. Detection of avulsion injuries in the mesentery of the small bowel; Use of computed tomography in diagnosing pancreatic and retroperitoneal injuries; Signs of urethral injury.

  • schistocelia.  // Taber's Cyclopedic Medical Dictionary (2009);2009, Issue 21, p2079 

    A definition of the term "schistocelia," which refers to a congenital abdominal fissure, is presented.

  • Covering the "open abdomen": a better technique. Sherck, John; Seiver, Adam; Shatney, Clayton; Oakes, David; Cobb, Luther; Sherck, J; Seiver, A; Shatney, C; Oakes, D; Cobb, L // American Surgeon;Sep1998, Vol. 64 Issue 9, p854 

    "Damage control" in severe abdominal trauma, abdominal compartment syndrome, necrotizing fasciitis of the abdominal wall, and necrotizing pancreatitis often preclude closure of the fascia after laparotomy. Many techniques have been reported for temporary coverage of the exposed viscera, but most...

  • The little rock weave. Barone, Gary W.; Broussard, Heath J.; Webb, John W.; Hudec, Wayne A. // American Surgeon;May1998, Vol. 64 Issue 5, p476 

    Describes a modified interrupted suture technique that may be useful for closure of difficult abdominal wounds. Placement of sutures without attempting to tie the knots; Type of suture material; Suturing procedure.

  • MANAGEMENT OF SILENT CYSTIC PHEOCHROMOCYTOMAS WITH BENIGN OR MALIGNANT HISTOLOGY. Yalin, G. Y.; Uzum, A.; Selcukbiricik, O.; Yegen, G.; Gul, N.; Barbaros, U.; Yarman, S. // Acta Endocrinologica (1841-0987);2015, Vol. 11 Issue 2, p195 

    Introduction. The differential diagnosis of abdominal cystic lesions should include investigation of cystic pheochromocytomas. To date only a few cases of purely cystic pheochromocytoma have been reported in the English literature. Aim. To present the management in four cases of silent...

  • Abdominal Wall Penetration by a Police 'Bean Bag.' Olivas, Terry; Jones, Bruce; Canulla, Marco // American Surgeon;May2001, Vol. 67 Issue 5, p407 

    Police departments across the country now have at their disposal a "nonlethal" weapon known as a "bean bag" shotgun. The bean bags, which come loaded in standard shotgun shells, are missiles intended to disable dangerous suspects without having to resort to lethal force. They were specifically...

  • Injectable foam for internal bleeding. PEDERSEN, AMANDA // Medical Device Daily;8/15/2013, Vol. 17 Issue 157, p6 

    The article reports that medical technology company Arsenal Medical, working with a 15.5 million dollars grant from the Defense Advanced Research Projects Agency (DARPA), is developing an injectable foam for delivery through the belly button of a wounded soldier to slow internal bleeding.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics