[Successful management of abdominal stab wounds with clinical evaluation: experiences of an South-African trauma unit with 496 consecutive patients].
BACKGROUND
Up to 80% of all operations performed in South African trauma units are due to penetrating injuries. This study will evaluate our own clinical guidelines for the management of penetrating abdominal injuries.


METHODS
Absolute indication for operation in patients with penetrating abdominal injuries have been: haemodynamic instability, evisceration of bowels or organs, peritonitis, free air under the diaphragm on plain abdominal x-rays, the evidence of fresh blood on rectal examination or in the stomach. No ultrasonography or CT scanning has been performed.


RESULTS
496 patients were included in this study. In 248 (50%) patients an operation has been performed. 50 (20%) of them were initially selected for abdominal observation. In 230 (93%) patients, peritoneal penetration was diagnosed during laparotomy. In 18 (7%) patients the laparotomy was negative and in 24 (10%) non-therapeutic.6 (2%) patients died. Specifically 93.2% (CI 90.2-96.2%), positive prediction 92.7% (89.5%-95.7%).


CONCLUSIONS
The clinical evaluation of patients with abdominal stab wounds is a safe method to detect possible fatal injuries in hospitals without unlimited access to ultrasonography and CT scanning. 80% of all patients with a selective conservative approach needed no operation.
Exadaktylos
A
A
Trauma Units of the Groote Schuur Hospital, University of Cape Town, South Africa. exaris@gmx.ch
Stettbacher
A
A
Edul
S
S
Nichols
A
A
Bautz
P
P
D000007:Abdominal Injuries / Q000145:classification / Q000175:diagnosis / Q000601:surgery*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000890:Anti-Infective Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis; D016001:Confidence Intervals; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D005839:Gentamicins / Q000008:administration & dosage; D006801:Humans; D007813:Laparotomy; D016013:Likelihood Functions; D008795:Metronidazole / Q000008:administration & dosage; D010406:Penicillins / Q000008:administration & dosage; D011182:Postoperative Care; D012307:Risk Factors; D013997:Time Factors; D014951:Wounds, Stab / Q000145:classification / Q000175:diagnosis / Q000601:surgery*
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D005839:Gentamicins; D010406:Penicillins; D008795:Metronidazole