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

• DOI: 10.1186/s12873-022-00687-5
• Publication Date: 2022-07-18T23:02:58Z
• Authors: Amitai Bickel; Konstantin Akinichev; Michael Weiss; Samer Ganam; Seema Biswas; Igor Waksman; Eli Kakiashvilli
• Keywords: Trauma Center; Medical record

Abstract Background During the Syrian civil war, patients were initially treated on-site in Syria and later transferred to medical centers Israel. Relevant details concerning exact nature of injury medical/surgical care received unavailable clinicians Many these required abdominal re-exploration for obvious or suspected problems related their injury. Our aim is present our approach trauma who survived initial surgery needed subsequent abroad, center. Methods Clinical data from all records retrospectively analyzed. Each patient underwent total body computerized tomography on arrival, revealing diverse multi-organ trauma. We divided population had into 4 sub-groups according location which surgical intervention was performed (abdominal only Syria, re-laparotomy Israel, management without intervention). focused missed injuries post-operative complications sub-group. Results By July 2018, 1331 been admitted hospital, whom 236 suffered Life-saving 138 before arrival A 79 46 (33%) re-laparotomy. The absence any communication between teams across border markedly affected approach. Indications included severe peritoneal inflammation, neglected overlooked foreign bodies, hemodynamic instability intestinal fistula. Mortality occurred 37/236 patients, with as main cause fatality 10 them (4.2%), usually following urgent Conclusions Lack information about circumstances an environment catastrophe at time professional dictated concerns that some looked deceptively stable while others potentially hidden injuries. no definitive versus damage control Syria. fact re-operation not by same team responsible also posed major diagnostic challenges warranted increased clinical suspicion a change standard