During the Syrian civil war, patients were initially treated on-site in Syria and later transferred to medical centers in Israel. Relevant details concerning the exact nature of injury and medical/surgical care received in Syria were unavailable to clinicians in Israel. Many of these patients required abdominal re-exploration for obvious or suspected problems related to their injury. Our aim is to present our approach to abdominal trauma patients who survived initial on-site surgery and needed subsequent abdominal re-exploration abroad, in our medical center. Clinical data from all medical records were retrospectively analyzed. Each patient underwent total body computerized tomography on arrival, revealing diverse multi-organ trauma. We divided the patient population who had abdominal trauma into 4 sub-groups according to the location in which abdominal surgical intervention was performed (abdominal surgery performed only in Syria, surgery in Syria and subsequent re-laparotomy in Israel, abdominal surgery only in Israel, and management of patients without abdominal surgical intervention). We focused on missed injuries and post-operative complications in the re-laparotomy sub-group. By July 2018, 1331 trauma patients had been admitted to our hospital, of whom 236 had suffered abdominal trauma. Life-saving abdominal intervention was performed in 138 patients in Syria before arrival to our medical center. A total of 79 patients underwent abdominal surgery in Israel, of whom 46 (33%) required re-laparotomy. The absence of any communication between the surgical teams across the border markedly affected our medical approach. Indications for re-exploration included severe peritoneal inflammation, neglected or overlooked abdominal foreign bodies, hemodynamic instability and intestinal fistula. Mortality occurred in 37/236 patients, with severe abdominal trauma as the main cause of fatality in 10 of them (4.2%), usually following urgent re-laparotomy. Lack of information about the circumstances of injury in an environment of catastrophe in Syria at the time and the absence of professional communication between the surgical teams across the border markedly dictated our medical approach. Our concerns were that some patients looked deceptively stable while others had potentially hidden injuries. We had no information on who had had definitive versus damage control surgery in Syria. The fact that re-operation was not performed by the same team responsible for initial abdominal intervention also posed major diagnostic challenges and warranted increased clinical suspicion and a change in our standard medical approach.

中文翻译：

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在现场腹部外伤手术和随后延迟到达国外最终医疗护理后，对战争伤员进行腹部重新探查的挑战——一种不寻常的情况

在叙利亚内战期间，患者最初在叙利亚接受现场治疗，后来被转移到以色列的医疗中心。以色列的临床医生无法获得有关在叙利亚接受的伤害和医疗/外科护理的确切性质的相关细节。其中许多患者需要腹部重新探查，以解决与受伤相关的明显或疑似问题。我们的目标是在我们的医疗中心向那些在最初的现场手术中幸存并需要随后在国外进行腹部重新探查的腹部创伤患者介绍我们的方法。对所有医疗记录的临床数据进行回顾性分析。每位患者在抵达时都接受了全身计算机断层扫描，显示出不同的多器官创伤。我们根据进行腹部手术干预的位置将腹部外伤患者分为 4 个亚组（仅在叙利亚进行的腹部手术、在叙利亚进行的手术以及随后在以色列进行的再次剖腹手术、仅在以色列进行的腹部手术、和没有腹部手术干预的患者的管理）。我们专注于再次剖腹手术亚组的遗漏损伤和术后并发症。截至2018年7月，我院收治外伤患者1331人，其中腹部外伤236人。在抵达我们的医疗中心之前，对叙利亚的 138 名患者进行了挽救生命的腹部干预。以色列共有 79 名患者接受了腹部手术，其中 46 名（33%）需要再次剖腹探查。跨境手术团队之间缺乏任何沟通明显影响了我们的医疗方法。重新探查的指征包括严重的腹膜炎症、被忽视或忽视的腹部异物、血流动力学不稳定和肠瘘。37/236 例患者死亡，其中 10 例（4.2%）以严重的腹部创伤为主要死因，通常在紧急再次剖腹探查术后。缺乏关于当时叙利亚灾难环境中受伤情况的信息，以及跨境手术团队之间缺乏专业沟通，明显决定了我们的医疗方法。我们担心的是，有些患者看起来很稳定，而另一些患者可能有潜在的伤害。我们没有关于谁在叙利亚进行了明确的损伤控制手术的信息。事实上，再次手术不是由负责初始腹部干预的同一团队进行的，这一事实也带来了重大的诊断挑战，需要增加临床怀疑和改变我们的标准医疗方法。