[Detection and emergency management of visceral injuries after abdominal trauma : Hollow organ and mesenteric injuries-keep in mind].

Hollow organ and mesenteric injuries occur in up to 7% of all cases of abdominal trauma and are linked to high morbidity and mortality, especially with delayed diagnosis and treatment. The causes include blunt, penetrating or blast injuries. Hollow organ injuries are more frequent in penetrating trauma, while injuries of the parenchymatous organs dominate in blunt trauma. The clinical diagnosis is difficult as the early symptoms are often nonspecific. Important predictors include abdominal tenderness, the seatbelt sign, leukocytosis, lactatemia and abnormalities in computed tomography (CT). The use of CT is considered the gold standard in the diagnostics but has limited sensitivity despite high specificity. Therefore, close clinical monitoring and, if necessary, repeated imaging is mandatory. Scoring systems, such as the bowel injury prediction score (BIPS) help identify injuries which require surgery. The treatment depends on the injury pattern and the condition of the patient. Stable patients without radiological signs of injury can initially be managed conservatively. Specific CT signs (e.g., pneumoperitoneum, bowel wall discontinuity) indicate the need for surgical exploration. Surgical options range from simple suturing to resection with primary anastomosis or placement of a stoma. In unstable patients damage control strategies including open abdomen therapy may be required.