[Emergency surgery in district hospital: massive hemorrhage after blunt abdominal injury]

In the management and prognosis of severe accident cases there are a number of conditions that occur before hospitalization which cannot be influenced, these are: no immediate medical care by a physician, delay in sending the patient to hospital, long journey time and alcoholic damage to the liver and CNS. Often, therefore, laparotomy for massive haemorrhage after abdominal injuries has to be done on a severely shocked patient with a "zero" BP. Diagnostic criteria in the evaluation of such cases are: the clinical picture, shock index, paracentesis (trial abdominal drainage) with additional laparoscopic examination and IVP. In a series of 45 laparotomies there were 25 single organ injuries; 19 multiple organ injuries and 1 negative laparotomy due to misinterpretation of the trial drainage. 22 splenectomies demonstrate the type of injury occurring in a country area. The good results of treatment despite the difficulties mentioned can, to some degree, be attributed to the technical improvement in vascular clips for large vessels. The Tantalum vascular clip offers the advantage of simple application, sure positioning and immediate arrest of haemorrhage thus reducing the shock phase; additional effects are the permanent indication of the bleeding site, the marking of anastomoses and resections and there being no foreign body reaction (pure Tantalum).