Abdominal trauma resulting from combat operations (a literature review)

Abstract

Aim. To summarize current evidence on the mechanisms of injury, diagnostic approaches, and treatment strategies for combat-related abdominal trauma, with a focus on modern surgical management. Materials and methods. A narrative literature review was conducted using PubMed, Scopus, and Google Scholar databases for the period 2020–2025. Publications addressing combat abdominal trauma, including injury mechanisms, diagnostic algorithms, and treatment strategies, were selected. The analysis considered clinical relevance and evidence quality. Results. Fragmentation and combined injuries predominate in modern combat settings and are associated with a high incidence of polytrauma. Focused Assessment with Sonography for Trauma (FAST) and computed tomography are key diagnostic tools for patient stratification and decision-making. Selective nonoperative management (SNOM) is effective in hemodynamically stable patients without signs of hollow viscus injury. Damage control surgery (DCS) remains the standard of care in patients with the “lethal triad”. The role of endovascular techniques, including angioembolization and resuscitative endovascular balloon occlusion of the aorta (REBOA), and enhanced recovery after surgery (ERAS) protocols adapted to austere environments has expanded. Conclusions. Combat-related abdominal trauma remains associated with significant mortality, particularly in patients with combined injuries. Timely diagnosis and a tailored treatment strategy (SNOM, DCS, and interventional approaches) are associated with improved outcomes. Further research is needed to optimize evidence-based management protocols and adapt ERAS principles to the austere combat environment.