Ballistic Thoracoabdominal Injury: Analysis of Recent Military Experience in Afghanistan

Abstract

Exploration remains the default treatment. Resuscitative thoracotomy may yield unexpected survivors, even if subsequent laparotomy is required. Nonoperative management appears to be feasible in a small proportion of patients but requires careful selection supported by cross-sectional imaging.

Current Controversies in Military Pre-Hospital Critical Care

“…Anticipated clinical course impalpable central pulses for which ECC is not necessary and which is associated with much improved survival compared with "genuine" PEA arrest. In keeping with this, a series of traumatic cardiac arrest survivors has been described from Afghanistan, some of whom never had ECC performed [28].…”

“…In civilian systems this is the group most likely to benefit from the procedure [34], although thoracotomy survivors from blunt trauma have also been reported [35]. In the Helmand trauma system, several good outcomes following emergency thoracotomy at Bastion have also been achieved [28,36]. Few of these survivors, however, have had cardiac tamponade; rather, the procedure has achieved temporary proximal vascular control through clamping of the aorta or pulmonary vessel.…”

Liver Trauma - Operative Management

“…The resultant wounds are usually the result of high energy transfer associated with large volumes of tissue destruction, multi-cavity involvement [20] and gross bacterial contamination [21].…”

Difficult Decisions in the Surgical Care of Military Casualties with Major Torso Trauma

“…Whilst many patients with chest and abdominal penetrating trauma can be managed with tube thoracostomy and laparotomy, a significant proportion will require thoraco-abdominal surgery. In the single recent military study of 27 patients with thoraco-abdominal trauma, nine of 20 patients requiring immediate surgery underwent exploration of both the abdominal and chest cavities [43]. The bulk of the published evidence lies in the civilian domain and represents a mixture of mechanisms (stab, gunshot) and populations treated in the pre-damage control resuscitation era.…”