[The role of an abdominal injury in follow-up of polytrauma patients].

Patients with multiple injuries were studied retrospectively (n = 483, ISS = 28 pts) and prospectively (n = 133, ISS = 42 pts) to determine the significance of concomitant intraabdominal lesions in the management and outcome of these subjects. In the retrospective part of the investigation 134 patients with intra-abdominal trauma presented with significantly more severe injuries (ISS = 38) as compared to 349 subjects with bland abdomen (ISS = 25). This resulted in a significantly different mortality rate (27 vs 11%). 119 patients with abdominal trauma were managed operatively, with surgery instituted within 4 hrs after the accident in 104 cases. Delayed abdominal surgery was performed in 18 patients due to complications from the initial laparotomy and in 15 cases because of delayed diagnosis. Delayed operations resulted in an increased rate of local complications (33 vs. 6%). In the prospective part of the study 33 out of 133 patients succumbed during resuscitation. In 14 of these, intractable bleeding from abdominal lesions was identified as the cause. In the 100 primary survivors, there was found no difference between 41 patients with and 59 patients without abdominal pathology with respect to injury severity, mortality, complications, initial hemodynamic parameters or the secondary release of inflammatory mediators. However, the initial requirement for red blood cell substitution was significantly higher in subjects with intra-abdominal trauma. Our results demonstrate that massive intra-abdominal hemorrhage may cause early mortality. In primary survivors, abdominal lesions have not shown to be of prognostic relevance, provided that early resuscitation, early diagnosis and early operative therapy can be instituted.