Penetrating injuries to the pelvis

Abstract

As criminality and weapon use increase, general and military surgeons are increasingly confronted with penetrating pelvic injuries both at home and on peacekeeping missions. Penetrating injuries to the iliac vascular axis are associated with considerable mortality, and thus the majority of these emergency patients arrive in a state of deep hypovolemic shock. Concomitant bowel injuries are present in one of five cases, resulting in contamination of the damaged area. Surgical options are simple lateral repair, ligation of the veins, temporary shunt insertion, and prosthetic graft interposition in the injured artery. In extremis ligation of the common or external iliac artery may be the only option to save the patient's life. Surgeons must be aware that damage control surgery and related methods may be needed early on to enable patient survival.

Stab wounds in a Swiss emergency department: a series of 80 consecutive cases

“…This increase seems to be observed in other European countries [3] and is confirmed by Exadaktylos et al in a similar setting in Switzerland with an increasing number of hospitalisations due to head trauma casualties [5]. The published studies deal mainly with patient stabilisation [6][7][8][9][10], emergency investigations [11][12][13] and specific treatment strategies [13][14][15][16][17][18]. The characteristics of the patients themselves and violence-linked morbidities are rarely analysed.…”

Intensivmedizinische Versorgung nach Abdominaltrauma

“…Die Mehrzahl der Patienten mit penetrierenden Verletzungen der Iliakalgefäße erreicht die medizinische Behandlung im hämorrhagischen Schock. Assoziierte Darmverletzungen, die in über 20% vorhanden sind, führen zu einer zeitgleichen Kontamination des Opera tionsgebiets [2]. Die Zeit bis zur operativen Versorgung von hämodynamisch instabilen Patienten mit penetrierenden Verletzungen ist der entscheidende Überlebensfak-tor.…”

“…Deshalb sollte die Stabilisierung bei diesen Patienten nicht die operative Versorgung verzögern. Frühzeitige Konversion in den Damage-Control-Modus kann verhindern, dass diese schwerstverletzten Patienten in die Koagulopathie abgleiten [2,3]. …”