This review brings a much needed scholarly assessment of abdominal blast overpressure injury to the surgical community. War always provides a vast learning environment for advancing knowledge of the epidemiology and pathophysiology of injury, and for improving therapeutics. Between periods of significant conflict, however, lessons learned are infrequently captured and the knowledge is rarely institutionalized so that it can be transferred to future generations. Today's era of increasing exposure to terrorist attacks sporadically introduces the civilian medical community to injuries that it has little or no experience of managing. Thus, present-day clinicians are well served by this article on abdominal blast overpressure injury, a type of injury that is dimly perceived by many and misunderstood by most. Although casualties from Iraq and Afghanistan present with abdominal blast overpressure injury only infrequently, changing trends in weapons and tactics may well increase the risk of this type of injury in the future. Explosive devices are more frequently being used against dense civilian populations, often in enclosed spaces where complex blast wave and quasistatic pressures are magnified. In this important paper, the authors correct a host of misconceptions in terms of epidemiology and pathophysiology, and correctly place substantial emphasis on clinical examination. Further, by illuminating the pathophysiology of intramural haematoma and late rupture, they alert clinicians to the importance of clinical follow-up. After the 2005 bombings in London, discussion at the Royal College of Surgeons of England amongst those of us involved in the Definitive Surgical Trauma Skills course concluded that every Hospital Trust should have a training programme to ensure surgical readiness for explosive injuries from terrorist activities. This article would be a staple for such a programme, which should be adopted as a policy by the National Health Service and others interested in providing optimal care for those injured by explosions in civilian or combat settings.
Language: en
", language="en", issn="0007-1323", doi="10.1002/bjs.7267", url="http://dx.doi.org/10.1002/bjs.7267" }