Non-operative management of abdominal stab wounds--an analysis of 186 patients.
BACKGROUND
The modern management of abdominal stab wounds remains controversial and subject to continued reappraisal. In the present study we reviewed patients with abdominal stab wounds to examine and validate a policy of selective non-operative management with serial physical abdominal examination in a busy urban trauma centre with a high incidence of penetrating trauma.


METHODS
Over a 12-month period (2005), the records of all patients with abdominal stab wounds were reviewed. Patients with abdominal stab wounds presenting with peritonitis, haemodynamic instability, organ evisceration and high spinal cord injury underwent emergency laparotomy. No local wound exploration, diagnostic peritoneal lavage or ultrasound was used. Haematuria in patients without an indication for emergency surgery was investigated with a contrasted computed tomography (CT) scan. Patients selected for non-operative management were admitted for serial clinical abdominal examination for 24 hours. Patients in whom abdominal findings were negative were given a test feed. If food was tolerated, they were discharged with an abdominal injury form.


RESULTS
One hundred and eighty-six patients with abdominal stab wounds were admitted. There were 171 (91.9%) males, with a mean age of 29.5 years. Seventy-four patients (39.8%) underwent emergency laparotomy. There were 5 negative laparotomies (6.8%). The remaining 112 patients (60.2%) were assigned for abdominal observation. One hundred (89.3%) of these patients were successfully managed non-operatively. The remaining 12 patients underwent delayed laparotomy, which was negative in 2 cases (16.7%). Non-operative management was successful in 53.8% of patients overall. The overall sensitivity and specificity of serial abdominal examination was 87.3% and 93.5%, respectively.


CONCLUSIONS
Serial physical examination alone for asymptomatic or mildly symptomatic patients with abdominal stab wounds enables a significant reduction in unnecessary laparotomies.
Navsaria
Pradeep H
PH
Trauma Centre, Department of Surgery, Groote Schuur Hospital, and Faculty of Health Sciences, University of Cape Town.
Berli
Jens U
JU
Edu
Sorin
S
Nicol
Andrew J
AJ
D000007:Abdominal Injuries / Q000601:surgery* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013019:South Africa; D014193:Trauma Centers; D014505:Urban Population; D014754:Violence; D014947:Wounds and Injuries / Q000601:surgery* / Q000628:therapy; D014950:Wounds, Penetrating / Q000601:surgery* / Q000628:therapy; D014951:Wounds, Stab