Surgical priorities of abdominal wounded in a combat situation

It is well established that abdominal wounded should be operated on as soon as possible. Combat conditions or mass casualty situations may dictate a delay in surgery because of higher priorities or lack of surgical facilities. A review of 178 abdominal wounded treated in an evacuation hospital during the 1973 and 1982 Israeli wars evaluates the effects of delay on mortality and complications. Surgery on 141 of the 178 abdominal casualties was delayed from 8 to 17 hours from the time of their injury. They were well supported hemodynamically along the chain of evacuation and none died en route. Mortality for the delay group was 5% and for the entire group 7.9%, which compares favorably with the 8.5% mortality during the latter part of the Vietnam War. Abdominal casualties who can tolerate delay in surgery are those who respond rapidly to vigorous volume replacement and remain stable with the aid of conventional supportive treatment.