A Brief Overview of Blunt Abdominal Trauma

A skilled surgeon with more than 26 years of experience, Clemens Gerstenkorn, MD, served as a consultant and trauma surgeon in Riyadh, Saudi Arabia. Over the course of his career, Dr. Clemens Gerstenkorn has performed a range of surgical procedures, including those used to treat blunt abdominal trauma. 

A commonly seen problem among emergency room physicians and surgeons, blunt abdominal trauma (BAT) accounts for around 80 percent of all abdominal injuries encountered in the emergency room. Although any severe blow can cause an abdominal injury, the majority of BAT cases are the result of auto accidents involving vehicle-to-vehicle collisions or vehicle-to-pedestrian collisions. 

Due to the presence of distracting injuries and delayed onset of related symptoms, BAT can be difficult to diagnose, even for the most experienced surgeons. Reliable signs that abdominal trauma may be present include pain, tenderness, and gastrointestinal hemorrhage. Physical marks caused by a lap belt, steering wheel, or another object can also indicate that the patient has an abdominal injury. 

After BAT is identified, using occasional diagnostic peritoneal lavage, computertomography, sonography, or other diagnostic methods, a physician may employ non-operative as well as surgical procedures to manage the injury. The spleen and liver are the most common focus of BAT treatment, but other organs, including the pancreas, bladder, bowel, mesentery and diaphragm, must also be examined for injury.

Identifying Acute Cholecystitis and Gallbladder Perforation

An experienced general and trauma surgeon, Clemens Gerstenkorn, MD, practiced medicine in numerous European cities for 24 years before moving to Saudi Arabia in 2014 to serve as a consultant and surgeon. Dr. Clemens Gerstenkorn has performed hundreds of surgeries on patients with a wide range of conditions and injuries, including acute cholecystitis with perforation of the gallbladder. 

Often caused by gallstones, acute cholecystitis is an inflammation of the gallbladder that can be dangerous if left untreated. The condition is most common in women, and the risk of developing acute cholecystitis rises as we age. The primary symptom is a long-lasting sharp pain or dull ache in the abdomen. Patients may also experience vomiting and nausea, fever, and abdominal bloating. 

One danger of acute cholecystitis is perforation of the gallbladder. Though rare, perforation can be difficult to diagnose, and a delay can prove fatal. Often, a perforation is identified only during surgery, though a ultrasound scan or a CT scan can also reveal the problem. Gallbladder perforation can cause many life-threatening issues, including a subhepatic or pelvic abscess, pneumonia, pancreatitis, sepsis and acute renal failure.

The Advantages of Laparoscopic Appendectomy

A graduate of Muenster University Medical School in Germany, Clemens Gerstenkorn, MD, has more than 25 years of experience as a surgeon. Skilled in acute care surgery, Dr. Clemens Gerstenkorn performs a wide range of procedures, including open and laparoscopic appendectomies.

An appendectomy refers to removal of the appendix, a small part of the large intestine located in the right lower portion of the abdomen. This procedure is used in cases of appendicitis, or infection of the appendix, in order to prevent complications from a possible rupture with infection of the abdominal cavity and sepsis. 

Rather than creating a large abdominal incision, the surgeon may perform a laparoscopic appendectomy, a minimally invasive technique that entails making a few small incisions in the abdomen. The surgeon then inserts a tiny camera that transmits a magnified image of the abdomen onto a large screen, which allows for safe removal of the appendix through the small incisions. The advantages of performing an appendectomy laprascopically include smaller scars, reduced pain, and faster recovery time. On the other hand it can spread the infection through the abdomen and the stump of the appendix will only be secured with staples. This can lead to leakage and later on to adhesions. An open appendectomy will avoid these complications and could be therefore advantageous especially in more advanced cases of appendicitis with abcess formation or bowel wall necrosis. Only time will tell as to which technique will develop into the gold standard for dealing with the different stages of acute appendicitis.

Hernia Types and Treatments

 

Dr. Clemens Gerstenkorn is an experienced surgeon who has served health care facilities in the United Kingdom, Germany, and Saudi Arabia. Over his career, Clemens Gerstenkorn, M.D., has built expertise in surgery to treat a range of conditions. Among the treatments Dr. Clemens Gerstenkorn provides is surgery for hernias.

A hernia is a section of organ protruding through a weakness in muscle, fascia and tissue. Hernias commonly develop in the upper and lower abdomen, but can also occur in the upper thigh, groin, and belly button. There are four categories of hernia: inguinal, hiatal, umbilical, and incisional.

Occurring in the lower abdomen or groin, inguinal hernias are the most common type. They occur primarily in men and are the result of intestines protruding through the lower abdomen or the inguinal canal. Hiatal hernias, where the stomach protrudes into the diaphragm, is mostly found in patients over 50 or in children who suffer from congenital defects. Umbilical hernias, where intestines press through the abdomen in or near the belly button, occur mostly in babies and young patients. Incisional hernias are the result of intestines protruding through incisions caused by previous surgery.

Hernias typically present as bulges in the groin or abdomen. If a hernia can be flattened - or reduced - by laying down or pressing on it, the condition requires medical attention but should not be considered an emergency. However, if a hernia does not flatten it may be a trapped, or incarcerated, hernia. Incarcerated hernias require immediate medical attention.

Laparoscopic Versus Open Inguinal Hernia Repairs

Clemens Gerstenkorn, MD, serves as a Consultant and surgeon at medical facilities across the world. Over the past five years, Dr. Clemens Gerstenkorn has treated over 200 hernias using both laparoscopic and open techniques. The most common form of hernias are groin, or inguinal, hernias, which occur more commonly in males. Surgical procedures to fix inguinal hernias require patients to undergo local/regional or general anesthetics. 

In open inguinal hernia repair, the surgeon makes an incision in the groin, dissects the hernia and its sack and pushes the content back into the abdominal cavity. The surgeon then repairs the weakness in the fascia and muscle layers, either directly by tightening of the transverse fascia to the inguinal ligament (original version: Bassini technique) or by doubling the fascia transversalis after complete surgical division, without tension (original version: Shouldice technique).The tissue can also be reinforced by using artificial material (mesh component, original technique Lichtenstein). The patient traditionally should stay in hospital for 2 to 3 days, but this period has been shortened more and more especially if the surgery has been done under regional anesthesia, to day surgery or 1 or 2 days hospital stay. 

In laparoscopic inguinal hernia repair, the surgeon makes several small incisions uses either a total extraperitoneal approach or a transperitoneal approach. The preperitoneal space or the abdomen cavity is inflated with carbon dioxide to create a working space. The surgeon then inserts a laparoscope --a lighted surgical camera--through one incision and surgical tools through others and fixes the hernia, always placing mesh over the weakened abdominal wall in these situations and thereby covering the hernia defect. Patients are typically discharged the same day or on day 1 after surgery and recovery usually takes one to two weeks. 
Laparoscopic surgery for inguinal hernia repairs has become more common over the last few years. The main reasons for this are lack of surgical experience and insufficient training for younger surgeons in mesh-free open hernia repairs; as explained above, open repairs require higher surgical skills and experience in excess of at least 200 cases. These simpler techniques however, can be learned quickly and implemented after a few operations. This is also the reason why these techniques are supported in the literature as having low recurrence rates. In reality, the reported recurrence rates are higher in laparoscopic and open mesh repairs as compared to the traditional open inguinal hernia repairs without mesh carried out by a competent experienced surgeon (Bassini, Shouldice). In any aspect, the recurrence rate of an inguinal hernia repair should not exceed 1 or maximum of 2%. The rate of mesh repair is normally not required in excess of 3 or 5% of cases. By avoiding the mesh, the patient is not exposed to artificial material and allergic reactions. If the hernia is incarcerated and a bowel resection is required, then an open operation without mesh is preferred as the risk of infection would otherwise be increased.

Inguinal Hernia Repair Options

A general surgeon with more than 25 years of experience, Clemens Gerstenkorn, MD, is skilled in acute-care surgery and surgical trauma management. Dr. Clemens Gerstenkorn has performed a diverse range of surgeries, from splenectomys and appendectomies to colon resections and hernia repairs. Over the last five years, Dr. Gerstenkorn has performed more than 190 hernia repairs, including those affecting the inguinal area. An inguinal hernia affects the groin area when tissue protrudes through a weak area in the abdominal muscle. Although an inguinal hernia can cause pain when an individual coughs or lifts something heavy, it is not always a dangerous condition. If the hernia grows or becomes painful, physicians often recommend surgery. Hernia repair can be performed either as an open surgery or as a minimally invasive (laparoscopic) procedure. The surgeon takes into account the patient’s prior surgical history and likelihood of recurrence in deciding on the best method. An open surgery entails making an incision in the groin and pushing the tissue back into place, after which the surgeon sutures the tissue and sometimes places a synthetic mesh to reinforce the weakened fascia. During a laparoscopic hernia repair, the surgeon makes several small abdominal incisions and fills the area with gas to enable observations of the patient’s organs. Using a small camera and surgical tools, the surgeon then repairs the hernia with synthetic mesh. While patients who undergo laparoscopic hernia may recover more quickly than those who undergo open surgery, hernia recurrence may be more likely after the minimally invasive approach. Patients should consult a surgeon with considerable experience in laparoscopic hernia repair to determine if they are good candidates for this procedure.

Clemens Gerstenkorn

Experienced Visceral and Trauma Surgeon Dr. Clemens Gerstenkorn

Dr. Clemens Gerstenkorn performs Visceral, Trauma and General surgery and is based in Germany. Over the last two decades, he has performed surgeries in numerous medical facilities and teaching hospitals across the globe. He has worked extensively in areas of General, Abdominal and Vascular surgery (involving renal access for dialysis).

During his time as a General Surgeon, Dr. Clemens Gerstenkorn has held positions with prestigious institutions including a University Hospital in Cologne, EU Hospital Kosovo, Columbus States University Ohio and one of the largest hospitals in Saudi Arabia.

Dr. Gerstenkorn attended medical school in Münster, Germany. He later taught medicine at the University of Münster’s department of General surgery.

In addition to his career as a surgeon and teacher, Dr. Clemens Gerstenkorn has published papers on a number of topics, including the “Outcome of Renal Allografts from Non-heart-beating Donors with Delayed Graft Function”.