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Abdominal trauma in war.
1General and Digestive Surgery Unit, American Hospital of Paris, Neuilly, France.
World Journal of Surgery
|September 1, 1992
Summary
Battlefield abdominal wounds are common, with nearly half of casualties dying from bleeding. Advances in surgical techniques have reduced mortality rates, but challenges remain in diagnosis and treatment, especially for colon injuries.
Area of Science:
- Trauma Surgery
- Military Medicine
- Surgical Pathology
Background:
- Penetrating abdominal injuries are a significant cause of battlefield casualties, often leading to immediate death from hemorrhage.
- Differences in wounding agents, delayed treatment, and diagnostic limitations distinguish war from civilian abdominal injuries.
- Management of colon lesions in wartime remains a complex and controversial surgical issue.
Purpose of the Study:
- To review the epidemiology and outcomes of abdominal wounds sustained in combat.
- To discuss the challenges and historical evolution of managing penetrating abdominal injuries in warfare.
- To analyze causes of mortality and factors influencing survival in battlefield abdominal trauma.
Main Methods:
- Review of historical data and surgical literature concerning abdominal trauma in various conflicts.
- Analysis of mortality rates and causes of death in documented cases of battlefield abdominal injuries.
- Examination of diagnostic approaches and surgical management strategies, including primary repair of colon lesions.
Main Results:
- Mortality rates for abdominal wounds have decreased from 53% in World War I to 18-36% by World War II, with some series in Vietnam reporting near 10% hospital mortality.
- However, other data from Vietnam indicate a 42% overall mortality, with hemorrhage (60%), sepsis (25%), and pulmonary insufficiency (15%) as primary causes of death.
- Exploratory laparotomy is standard for penetrating abdominal injuries due to unsophisticated diagnostics, with 10-20% negative findings. Survivors averaged 1.8 injured organs.
Conclusions:
- While surgical advancements have improved survival rates for battlefield abdominal injuries, significant challenges persist.
- Hemorrhage, sepsis, and pulmonary insufficiency remain critical determinants of mortality.
- Further research and refined protocols are needed for optimal management of complex abdominal trauma in combat settings, particularly concerning colon injuries.