Complex War Injuries: Addressing the Needs of the War Wounded

Fig. 25.1

A drain was sutured into the left renal pelvis before transfer to Israel

The left chest drain was removed and a new drain inserted. The patient then underwent relaparotomy. The small and large intestines were found to be intact. Splenectomy was confirmed. The tail of the pancreas had been resected and sutured. There was no active bleeding from the liver. A drain had been sutured into the left renal pelvis. The drain was removed, and the severed ends of the left ureter were anastomosed over a JJ stent. The abdomen was lavaged and drains replaced.

Postoperatively, the patient was ventilated on the intensive care unit for 2 days and then transferred to the ward, where he made a steady clinical recovery. Resistant organisms were cultured from the sputum (endotracheal tube) and the rectum: extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae and E. coli, respectively. He completed a course of intravenous tazocin and gradually built up to a normal diet. His sleep was disturbed, and his mental health remained a concern.

25.2 Teaching Points

The management of the Syrian war wounded has evolved into a protocol which includes full assessment along advanced trauma life support (ATLS) principles in the trauma room, total body CT, an antibiotic regime that takes into consideration a prevalence of antimicrobial resistance, and the policy to reexplore all patients who have undergone laparotomy in Syria [1–5]. This has enabled us to learn exactly what procedures patients have undergone in Syria (we receive no referral letters), look for missed injuries, complete staged procedures, and lavage the abdomen.

25.3 Clinical Implications

Patients are routinely assessed by a dietician and physiotherapist, and in this instance, a psychiatrist also consulted. We are well aware that the post-traumatic stress that patients from Syria suffer is underdiagnosed and undertreated. This is a priority as we seek to rehabilitate patients and help them reintegrate into society.

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