Challenges in abdominal re-exploration for war casualties following on-site abdominal trauma surgery and subsequent delayed arrival to defnitive medical care abroad – an unusual scenario

Challenges in abdominal re-exploration for war casualties following on-site abdominal trauma surgery and subsequent delayed arrival to defnitive medical care abroad – an unusual scenario

Abdominal surgery, Re-laparotomy, Damage control surgery, Abdominal trauma, Missed injuries,
War injuries

Background: During the Syrian civil war, patients were initially treated on-site in Syria and later transferred to medical
centers in Israel. Relevant details concerning the exact nature of injury and medical/surgical care received in Syria
were unavailable to clinicians in Israel. Many of these patients required abdominal re-exploration for obvious or
suspected problems related to their injury. Our aim is to present our approach to abdominal trauma patients who
survived initial on-site surgery and needed subsequent abdominal re-exploration abroad, in our medical center.
Methods: Clinical data from all medical records were retrospectively analyzed. Each patient underwent total body
computerized tomography on arrival, revealing diverse multi-organ trauma. We divided the patient population who
had abdominal trauma into 4 sub-groups according to the location in which abdominal surgical intervention was
performed (abdominal surgery performed only in Syria, surgery in Syria and subsequent re-laparotomy in Israel,
abdominal surgery only in Israel, and management of patients without abdominal surgical intervention). We focused
on missed injuries and post-operative complications in the re-laparotomy sub-group.
Results: By July 2018, 1331 trauma patients had been admitted to our hospital, of whom 236 had sufered abdominal trauma. Life-saving abdominal intervention was performed in 138 patients in Syria before arrival to our medical
center.
A total of 79 patients underwent abdominal surgery in Israel, of whom 46 (33%) required re-laparotomy. The absence
of any communication between the surgical teams across the border markedly afected our medical approach. Indications for re-exploration included severe peritoneal infammation, neglected or overlooked abdominal foreign bodies,
hemodynamic instability and intestinal fstula. Mortality occurred in 37/236 patients, with severe abdominal trauma as
the main cause of fatality in 10 of them (4.2%), usually following urgent re-laparotomy.
Conclusions: Lack of information about the circumstances of injury in an environment of catastrophe in Syria at
the time and the absence of professional communication between the surgical teams across the border markedly

Amitai Bickel, Konstantin Akinichev, Michael Weiss, Samer Ganam, Seema Biswas, Igor Waksman and Eli Kakiashvilli

BMC Emergency Medicine

(2022) 22:132

Fajar Bagus W

PDF

English

Text