Contents


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
