title: Unnecessary laparotomy by using physical examination and different diagnostic modalities for penetrating abdominal stab wounds.
abstract: BACKGROUND
  The modern management of penetrating abdominal trauma has decreased the incidence of unnecessary laparotomy by using selective non-operative management protocols. However, the real benefits of physical examination and different diagnostic methods are still unclear.
  
  
  METHODS
  From January 2000 to April 2003, we prospectively collected data on 117 patients with penetrating stab wounds to the thoracoabdominal, anterior abdominal, and back regions who had non-operative management. Clinical examination was the primary tool to differentiate those patients requiring operation. Findings of physical examination, ultrasound, computed tomography, endoscopy, echocardiography, diagnostic peritoneal lavage, and diagnostic laparoscopy were reviewed. The number of therapeutic, non-therapeutic, and negative laparotomies were recorded.
  
  
  RESULTS
  Non-operative management was successful in 79% of patients. There were 11 early (within 8 hours of admission) and 14 delayed (more than 8 hours after admission) laparotomies performed, depending on the results of various diagnostic procedures. Non-operative management failed in 21% of patients, and the rate of non-therapeutic laparotomy in early and delayed laparatomy groups was 9% and 14% respectively. There was no negative laparatomy.
  
  
  CONCLUSIONS
  The use of physical examination alone and/or together with different diagnostic methods allows reduction of non-therapeutic laparotomies and elimination of negative laparatomies.
authors.affiliation: Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. cemalettin@ertekin.info
authors.forename: C
authors.initials: C
authors.lastname: Ertekin
authors.forename: H
authors.initials: H
authors.lastname: Yanar
authors.forename: K
authors.initials: K
authors.lastname: Taviloglu
authors.forename: R
authors.initials: R
authors.lastname: Güloglu
authors.forename: O
authors.initials: O
authors.lastname: Alimoglu
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis*; D000293:Adolescent; D000328:Adult; D003113:Colonoscopy / Q000706:statistics & numerical data; D004452:Echocardiography / Q000706:statistics & numerical data; D005260:Female; D006300:Health Services Misuse; D006801:Humans; D007813:Laparotomy / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010533:Peritoneal Lavage / Q000379:methods; D010808:Physical Examination / Q000379:methods*; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D014951:Wounds, Stab / Q000175:diagnosis*