Damage control surgery in severe abdominal trauma

The concept of treating severe abdominal trauma according to the principles of damage control surgery is becoming more widespread in Germany. Damage control surgery is indicated when evidence of AHC syndrome, meaning the combination of acidosis, hypothermia and coagulopathy, is found. The preferred surgical approach is the median laparotomy. In hollow organ injury a primary anastomosis should not be forced; contamination control is far more important. Methods of choke are construction of an anus preter or temporary blind dosure. In the case of splenic injury total splenectomy is commonly performed. Liver injuries with massive bleeding should be controlled by packing or interim vascular occlusion, with subsequent temporary closure of the abdominal wall. Definitive organ repair should follow stabilization in the intensive care unit.