Penetrating abdominal trauma: the challenge.
High-velocity missiles fired from weapons of war cause severe injuries because of the intense energy that they transfer on impact with the living targets. The most important factors in the reduction of morbidity and mortality are first aid, rapid evacuation of victims and early primary surgery. Infection of wounds can arise from skin organisms and from enteric aerobes and anaerobes. Wounds involving the colon present particular problems due to bacterial contamination and the insecurity of suturing which can result in leakage. Although prompt surgery is a prerequisite for the successful treatment of patients with high-velocity abdominal wounds, early administration of appropriate antibiotics reduces morbidity and mortality since many post-surgical deaths are related to septic complications. Penetrating abdominal wounds encountered in most hospital emergency departments are usually caused by knives and low-velocity pistol bullets. However, in the prevention of infection, no standard optimal antibiotic regimen or length of treatment has been established. Combination regimens with aminoglycoside antibiotics have been widely used, but single beta-lactam regimens are an attractive alternative because of their wide anti-microbial spectrum and cost effectiveness. Short-term antibiotic regimens are as efficacious as long-term treatment, but certain risk factors must be considered.