title: Diagnosis of injuries after stab wounds to the back and flank.
abstract: BACKGROUND
  Historically, patients with deep posterior wounds underwent a formal celiotomy to rule out injury. Currently, we use a policy of selective management. The purpose of this review is to evaluate our experience with selective management to identify potential areas of further improvement.
  
  
  RESULTS
  This study includes 203 patients over a 10-year period. By changing from a policy of mandatory exploration to selective management the total celiotomy rate decreased from 100 to 24% and the therapeutic celiotomy rate increased from 15 to 80%.
  
  
  CONCLUSIONS
  In stable patients, a diagnostic peritoneal lavage should be performed as the initial diagnostic study. When diagnostic peritoneal lavage is negative, triple contrast computed tomography should be performed to evaluate the remaining retroperitoneal structures. Any suggestion of pericolonic extravasation of contrast or air, edema, or hemorrhage must be interpreted as a positive study and prompt consideration for operative exploration.
authors.affiliation: Department of Surgery, Harborview Medical Center, University of Washington, Seattle 98104, USA.
authors.forename: E M
authors.initials: EM
authors.lastname: Boyle
authors.forename: R V
authors.initials: RV
authors.lastname: Maier
authors.forename: J D
authors.initials: JD
authors.lastname: Salazar
authors.forename: J C
authors.initials: JC
authors.lastname: Kovacich
authors.forename: G
authors.initials: G
authors.lastname: O'Keefe
authors.forename: F A
authors.initials: FA
authors.lastname: Mann
authors.forename: A J
authors.initials: AJ
authors.lastname: Wilson
authors.forename: M K
authors.initials: MK
authors.lastname: Copass
authors.forename: G J
authors.initials: GJ
authors.lastname: Jurkovich
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D019567:Back Injuries; D002648:Child; D002675:Child, Preschool; D004906:Erythrocyte Count; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012187:Retroperitoneal Space / Q000293:injuries; D014057:Tomography, X-Ray Computed; D014951:Wounds, Stab / Q000150:complications*