Selective clinical management of anterior abdominal stab wounds

Am J Surg. 2004 Dec;188(6):807-12. doi: 10.1016/j.amjsurg.2004.08.046.

Abstract

Background: The optimal management of clinically stable patients with anterior abdominal stab wounds (AASWs) is debated. We implemented a protocol of serial clinical assessments to determine the need for laparotomy. The purpose of this study was to determine whether the approach is safe and effective.

Methods: Records of patients sustaining AASWs from 1999 to 2003 were reviewed.

Results: Seventy-seven patients sustained AASWs. Twenty-five were taken directly to the operating room because of hypotension (5), evisceration (7), or peritonitis (15). Seventeen patients had diagnostic peritoneal lavage (DPL) for associated thoracoabdominal wounds and 5 had local wound exploration (LWE) off protocol. The remaining 30 patients were managed with serial clinical assessments and were discharged uneventfully.

Conclusion: Patients sustaining AASWs who present without hypotension, evisceration, or peritonitis may be managed safely under a protocol of serial clinical evaluations. This approach should be compared with LWE/DPL in a prospective, randomized multicenter trial.

Publication types

  • Comparative Study

MeSH terms

  • Abdominal Injuries / diagnosis
  • Abdominal Injuries / mortality
  • Abdominal Injuries / surgery*
  • Adult
  • Aged
  • Cohort Studies
  • Female
  • Health Services Needs and Demand
  • Hemoperitoneum / diagnosis*
  • Hemoperitoneum / surgery
  • Humans
  • Injury Severity Score
  • Laparoscopy / methods
  • Laparotomy / methods*
  • Male
  • Middle Aged
  • Peritoneal Lavage
  • Prognosis
  • Retrospective Studies
  • Risk Assessment
  • Survival Rate
  • Treatment Outcome
  • Wounds, Stab / diagnosis
  • Wounds, Stab / mortality
  • Wounds, Stab / surgery*