Management of penetrating abdominal trauma: what we need to know?

• Published in: Annales françaises d'anesthésie et de réanimation 2013-02, Vol.32 (2), p.104-111
• Main Authors: Hoffmann, C, Goudard, Y, Falzone, E, Leclerc, T, Planchet, M, Cazes, N, Pons, F, Lenoir, B, Debien, B
• Format: Article
• Language: fre
• Subjects: Abdominal Injuries - complications; Abdominal Injuries - diagnosis; Abdominal Injuries - mortality; Abdominal Injuries - surgery; Abdominal Injuries - therapy; Anesthesia; Antifibrinolytic Agents - therapeutic use; Emergency Medical Services; France - epidemiology; Humans; Patient Care Management; Tomography, X-Ray Computed; Tranexamic Acid - therapeutic use; Wounds, Penetrating - complications; Wounds, Penetrating - diagnosis; Wounds, Penetrating - mortality; Wounds, Penetrating - surgery; Wounds, Penetrating - therapy; Wounds, Stab - therapy
• ISSN: 1769-6623
• DOI: 10.1016/j.annfar.2012.12.006

Penetrating traumas are rare in France and mainly due to stabbing. Knives are less lethal than firearms. The initial clinical assessment is the cornerstone of hospital care. It remains a priority and can quickly lead to a surgical treatment first. Urgent surgical indications are hemorrhagic shock, evisceration and peritonitis. Dying patients should be immediately taken to the operating room for rescue laparotomy or thoracotomy. Ultrasonography and chest radiography are performed before damage control surgery for hemodynamic unstable critical patients. Stable patients are scanned by CT and in some cases may benefit from non-operative strategy. Mortality remains high, initially due to bleeding complications and secondarily to infectious complications. Early and appropriate surgery can reduce morbidity and mortality. Non-operative strategy is only possible in selected patients in trained trauma centers and with intensive supervision by experienced staff.