Preface

Diagnosing and treating abdominal trauma is dangerous and complex. Injury to the abdomen can be isolated or combined with other types of trauma. It can cause damage to internal organs accompanied by life-threatening bleeding, the development of peritonitis, purulent-septic complications, and loss of functions of organs and systems. Abdominal trauma accounts for 5% of all injuries and ranks third among the most common traumas in emergency medicine, after acute appendicitis and acute cholecystitis. Among peacetime injuries, that is, injuries sustained outside of military operations, isolated abdominal trauma accounts for 15%–20% of injuries; however, abdominal trauma is more often combined with injuries to other anatomical areas. The frequency of diagnostic errors in combined injuries ranges from 7% to 25%. The frequency of unjustified laparotomies in closed abdominal trauma ranges from 28% to 46%. The frequency of intestinal damage occurring with a closed abdominal trauma ranges from 6.3% to 38.5%; the mortality rate in these cases is 12%–15%. With ruptures of the mesentery of the intestine and the intestinal wall with peritonitis, the mortality rate is 19%–24%. The frequency of intestinal damage in gunshot wounds of the abdomen is 37.2%–84.3%. In 66%–82% of cases, several organs are damaged simultaneously. The liver is second only to the intestines in terms of the frequency of damage caused by abdominal trauma. The mortality rate in patients with a closed abdominal trauma is 21.7%–68%. Those who die from liver injuries account for 15%–20% of all those who die from injuries. Many victims die at the scene or during transportation. About 15.2%–23.4% of the victims die shortly after hospitalization due to the extreme severity of the condition and the complexity of diagnosis against the background of an intra-abdominal catastrophe. The frequency of gunshot wounds to the liver with penetrating abdominal wounds is 25.3%–73.3%. The mortality rate for stab wounds of the liver is 9.2%–35.3%. The spleen is one of the most life-threatening injured organs in abdominal trauma because of its high vascularity and vulnerable anatomical location. Spleen injury occurs in 16%–50% of closed abdominal trauma cases. Pancreatic injuries are observed in 1%–22% of closed abdominal trauma and penetrating abdominal wound cases. They are characterized by a severe course with the development of post-traumatic pancreatitis. The frequency of pancreatic injury with abdominal trauma is as high as 87.7%, the rate of complications can reach 77%, and the mortality rate is 10%–72%. Pancreatic injury is often combined with damage to the liver, stomach, spleen, intestines, and large vessels. The clinical picture depends on the localization of injuries, their severity, and developing complications. Characteristic features of modern abdominal trauma are the multiplicity and severity of injuries accompanied by gross violations of homeostasis and disorders of vital functions of the body. This circumstance requires urgent actions, the primary goals of which are to restore the functions of the body and determine the indications for emergency surgery. It should be noted that in the last decade there have been many reports about the use of minimally invasive technologies in the diagnosis and treatment of abdominal trauma. To improve the outcomes of the most severe polytrauma, the "damage control" principle

was proposed. "Damage control" surgery is a series of operations performed to accomplish definitive repair of abdominal injuries in accordance with the patient's physiologic tolerance. Trauma surgeons focus more on the physiological reserve of the patient rather than the anatomy of the lesions. Surgical techniques are focused on hemorrhage and contamination control to stop bleeding and control intestinal, biliary, or urinary leakage into the abdominal cavity. Literature data confirm the effectiveness of this method, demonstrating a reduction in mortality and immediate postoperative complications.

Written by an international team of highly qualified specialists, this book will be of interest to anyone who has engaged in emergency abdominal surgery.

> **Dmitry Victorovich Garbuzenko** Professor, Department of Faculty Surgery, South Ural State Medical University, Chelyabinsk, Russia

**Chapter 1**

**1. Introduction**

gastrointestinal tract [2].

complications and adverse outcomes.

Introductory Chapter: Abdominal

"The first doctor invited to the victim should remember that he has three tasks: (1) take measures against shock; (2) recognize damage to the internal dense organ the cause of internal bleeding; and (3) recognize damage to the hollow organ—the cause of hyperacute peritonitis. He should also know that all injuries, without any exception, are subject to the competence of the surgeon and require extreme urgency. Whether it is a perforation of the intestine and infection of the peritoneum, or a rupture of a dense internal organ and bleeding—it doesn't matter, in either case, the

Closed injuries and abdominal wounds have always been a difficult surgical problem. The presence of many vital organs in the abdominal cavity, the specifics of their anatomical structure, vascular architectonics and innervation, the immediate proximity of intestinal contents rich in pathogenic flora, the presence of organs producing extremely active enzymes—all this leads to massive internal bleeding, rapid development of peritonitis, and the occurrence of irreversible changes in organs and tissues. As with no other injury, abdominal trauma requires accurate and rapid diagnosis, thoughtful and adequate surgical tactics, and the ability to predict the dynamics of the development of pathological changes occurring in parenchymal organs and the

As a rule, abdominal trauma differ in the severity of the general condition, internal bleeding, the development of shock, the distinct dependence of treatment outcomes on the timing of surgery, the complexity, complexity of the operation, and the need for particularly careful management of the patient in the postoperative period. Even in peacetime, they are accompanied by a significant frequency of

is men of working age, which makes the problem particularly relevant [3].

and a high frequency of postoperative complications—10–27% [4].

Over the past 20 years, serious changes have taken place in the structure of abdominal trauma due to the steady increase in the number of road accidents, falls from heights, man-made disasters, natural disasters, and local military conflicts. The characteristic features of modern abdominal trauma are the multiplicity and severity of injuries accompanied by gross violations of homeostasis and disorders of vital functions of the body, which causes a high, nondecreasing mortality rate—6.1–26%

Abdominal trauma account for up to 1/3 of peacetime injuries, and their frequency and severity, despite the downward trend, remain high. The main part of the victims

Trauma – An Update

victim is in mortal danger and the minutes are counted" [1].

*Dmitry Victorovich Garbuzenko*

**Chapter 1**
