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Schockraumdiagnostik: Initiale Diagnostik beim stumpfen Abdominaltrauma

Eine Literaturübersicht

Initial diagnosis after blunt abdominal trauma: A review of the literature

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Zusammenfassung

Fragestellung.

Das stumpfe Abdominaltrauma tritt meist im Rahmen eines Polytraumas auf und stellt neben dem SHT die häufigste Ursache für das frühe Versterben des schwerstverletzten Patienten dar. Daher ist eine unverzügliche Diagnostik abdomineller Verletzungen von entscheidender Bedeutung.

Methodik.

Klinische Studien wurden über systematische Literatursuchen (Medline, Cochrane und Handsuche) und Klassifikation nach Evidenzgüte (Level 1–5 nach Oxford-Schema) zusammengetragen.

Ergebnisse.

Die alleinige klinische Untersuchung des Abdomens zur Diagnostik einer intraabdominellen Verletzung ist nicht verlässlich. Die Sonographie des Abdomens, insbesondere das alleinige Screening nach freier Flüssigkeit (FAST) ist nicht ausreichend sensitiv. Die Computertomographie des Abdomens stellt dagegen derzeit den Goldstandard dar. Die diagnostische Peritoneallavage (DPL) findet trotz nachgewiesener hoher Sensitivität nur in Ausnahmen Anwendung. Beim persistierend kreislaufinstabilen Patienten und Nachweis von freier Flüssigkeit im Abdomen sollte ohne Verzug die Notfallaparotomie erfolgen.

Schlussfolgerungen.

Nach Abdominaltrauma sollte im Schockraum zunächst eine Abdomensonographie zum Nachweis freier Flüssigkeit und Screening auf Organläsionen erfolgen. Unabhängig davon ist nach stumpfem Abdominaltrauma beim ausreichend kreislaufstabilen Patienten zur sicheren Diagnostik einer intraabdominellen Verletzung eine Computertomographie des Abdomens durchzuführen.

Abstract

Objective.

Blunt abdominal trauma is most common in the polytraumatized patient and beside neurocranial trauma one major determinant of early death in these patients. Therefore, immediate recognition of an abdominal injury is of life-saving importance.

Methods.

Clinical trials were systematically collected (Medline, Cochrane and hand searches) and classified into evidence levels (1 to 5 according to the Oxford system).

Results.

Clinical examination is not reliable for evaluation of abdominal injury. Abdominal ultrasound, especially if only focusing on free fluid (FAST) is not sensitive enough. Today, CT-scan of the abdomen is the gold-standard in diagnosing abdominal injury. Diagnostic Peritoneal Lavage (DPL) has a high sensitivity but in our region only is used in exceptional cases. The patient with continuing hemodynamical instability after abdominal trauma and evidence of free intraperitonial fluid has to undergo laparotomy.

Conclusion.

After blunt abdominal trauma, initially ultrasound investigation should be performed in the emergency room. This should not only focus on free intraabdominal fluid but also on organ lesions. Regardless of the findings from ultrasound or clinical examination, the hemodynamically stable patient should undergo a CT-scan of the abdomen in order to proof or exclude an abdominal injury.

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Authors and Affiliations

  1. Centrum für Muskuloskeletale Chirurgie, Klinik für Unfall- und Wiederherstellungschirurgie, Charité—Universitätsmedizin Berlin

    T. Lindner, H. J. Bail, S. Manegold, U. Stöckle & N. P. Haas

  2. Klinik für Unfall- und Wiederherstellungschirurgie, Charité Campus Virchow, Augustenburger Platz 1, 13353, Berlin

    T. Lindner

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  1. T. Lindner
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Correspondence to T. Lindner.

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Lindner, T., Bail, H.J., Manegold, S. et al. Schockraumdiagnostik: Initiale Diagnostik beim stumpfen Abdominaltrauma. Unfallchirurg 107, 892–902 (2004). https://doi.org/10.1007/s00113-004-0849-0

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