Aktuelle Therapie der Verletzungen von Colon und Retroperitoneum

Abstract

Injuries of the colon and retroperitoneum are rarely observed after blunt abdominal trauma and occur in about 5 - 20 % of the patients. The majority of complications are due to initial misdiagnoses and a delay in treatment. Lesions of the pancreas and duodenum are the most frequent diagnoses in the retroperitoneal space, while major vascular traumata or urogenital injuries are rare. Retroperitoneal hematoma are most likely due to pelvic fractures. The survival of patients after colon or retroperitoneal injuries depends on the severity of concomitant organ trauma, the time of diagnosis, and a situation-adapted therapeutic strategy. The treatment of the typical caudal retroperitoneal hematoma following pelvic fractures is conservative in most patients. Early pelvic stabilization, e. g., with external fixation, is recommended in these patients. Central retroperitoneal hematoma in the supra - or inframesocolic space should be treated surgically, as major vascular injuries are most likely in these patients. Duodenal or pancreatic injuries need surgical exploration in the majority of patients; the therapeutic spectrum ranges from simple sutures to pancreatoduodenal resection. The treatment of colon injuries depends on the degree of peritonitis and the severity of concomitant trauma. Early diagnosed injuries are suitable for primary repair, while deviation stomata or a Hartmann procedure with or without resection should be offered to patients with delayed diagnoses, peritonitis, or severe concomitant diseases. Long-lasting procedures should be abandoned in the emergency situation; in these severe cases, laparotomy should be aimed towards primary "damage control" and followed by definite surgery after stabilization of the patient.