| Abstract | Trauma trbuha posljedica je djelovanja tupog ili prodornog mehanizma u kojem sila velike
energije zahvaća trbušnu stijenku. Vrsta i stupanj ozljede ovise o mehanizmu i jačini djelovanja
sile, fizičkom stanju bolesnika te vrsti korištenog oružja. Ozljeda može zahvatiti bilo koje tkivo
trbušne šupljine, od kože, mišića i potkožnog tkiva pa sve do solidnih organa i krvnih žila.
Dijagnoza se temelji na anamnezi, kliničkom pregledu, laboratorijskim nalazima i radiološkim
pretragama. U kliničkom pregledu prevladavaju nespecifični simptomi poput boli ili
osjetljivosti trbuha, tahikardije, povraćanja i hipotenzije. Specifični nalazi koji pobuđuju
sumnju na ozljedu trbušnih organa uključuju ekhimozu, kontuziju ili hematom trbušne stijenke,
pojasasto širenje boli, spontanu bol i hiperesteziju u području lijevog ramena, krepitacije donjih
rebara, bolnost pri kompresiji obiju kristi zdjelice te znakove nadražaja peritoneuma. Od
radioloških pretraga najčešće se koriste rendgen (RTG), ultrazvuk (UZV) i kompjutorizirana
tomografija (CT) s kontrastom. RTG pomaže u otkrivanju pneumoperitoneuma, odnosno
prisutnosti zraka u trbušnoj šupljini, što ukazuje na rupturu pojedinog organa, dok je UZV
odlična metoda za brzo otkrivanje prisutnosti slobodne tekućine u trbušnoj šupljini u
hemodinamski nestabilnih bolesnika. CT snimka s kontrastom, osim slobodne tekućine,
omogućuje i detaljniji prikaz ozljede solidnih organa, a koristi se kod hemodinamski stabilnih
pacijenata. Liječenje bolesnika s traumom trbuha, ovisno o vrsti ozljede i kliničkom stanju
pacijenta, može biti konzervativno ili kirurško. Konzervativno liječenje provodi se u
hemodinamski stabilnih bolesnika koji nemaju indikacije za laparotomiju, dok će
hemodinamski nestabilni bolesnici te oni sa značajnijim ili pridruženim ozljedama okolnih
tkiva zahtijevati kirurško liječenje, odnosno eksploraciju i evaluaciju ozljede trbušne šupljine,
a zatim i njeno zbrinjavanje. Vrsta kirurške intervencije ovisi o mjestu ozljede te iskustvu i
odabiru kirurga. Važno je na vrijeme prepoznati ili postaviti sumnju na traumu trbuha, budući
da je neprepoznata ozljeda ili neadekvatno liječenje povezano s većim rizikom nastanka
komplikacija i mortaliteta. |
| Abstract (english) | Abdominal trauma is the result of the action of a blunt or penetrating mechanism in which a
force of great energy affects the abdominal wall. The type and degree of injury depends on the
mechanism and strength of the force, the physical condition of the patient and the type of the
weapon used. The injury can affect any tissue of the abdominal cavity, from skin, muscles and
subcutaneous tissue up to solid organs and blood vessels. Diagnosis is based on clinical
examination, medical history, laboratory findings and radiological imaging. Clinical
examination is predominated by non-specific symptoms such as abdominal pain or tenderness,
tachycardia, vomiting or hypotension. Specific findings suggestive of abdominal injury include
ecchymosis, contusion or hematoma of the abdominal wall, band-spreading painpain,
spontaneous pain and hyperesthesia in the left shoulder, crackles on palpation of the lower ribs,
pain on pelvic compression, and signs of peritoneal irritation. X-ray, ultrasound (US) and
computed tomography (CT) with contrast are the most commonly used radiological imaging
methods. X-ray helps to detect pneumoperitoneum, i.e. the presence of air in the abdominal
cavity, which indicates rupture of an organ, while ultrasound is an excellent method for rapid
detection of the presence of free fluid in the abdominal cavity in hemodynamically unstable
patients. Contrast-enhanced CT provides a more detailed view of solid organ injury, in addition
to free fluid and is used in hemodynamically stable patients. Treatment of patients with
abdominal trauma, depending on the type of injury and the clinical condition of the patient, can
be either conservative or surgical. Conservative treatment is performed in hemodynamically
stable patients who have no indications for laparotomy, while hemodynamically unstable
patients and those with significant or associated injuries to surrounding tissues will require
surgical treatment, exploration and evaluation of abdominal injury, followed by its
management. The type of surgical intervention depends on the location of the injury and the
experience and choice of the surgeon. It is important to identify or suspect abdominal trauma
in a timely manner, as unrecognized injury or inadequate treatment is associated with a higher
risk of complications and mortality. |
