The impact of published recommendations on the management of penetrating abdominal injury.
BACKGROUND
In patients with penetrating abdominal injury (PAI), haemodynamic instability and peritonitis are indications for laparotomy, but it remains uncertain whether laparotomy is indicated for evisceration, retained foreign body and pneumoperitoneum. In 1989, a review of 107 patients with PAI revealed a 78.5 per cent laparotomy rate, with 35 per cent considered unnecessary. The aim of this study was to review current practice in the same hospitals.


METHODS
A retrospective review included case notes from 224 patients with PAI presenting to three hospitals between 2001 and 2005.


RESULTS
Some 206 patients (92.0 per cent) were male and the mean age was 30.5 years. Aetiologies were stabbing (96.4 per cent), impalement (2.7 per cent) and gunshot wound (0.9 per cent). Laparotomy was performed in 48 patients (21.4 per cent), and was positive in 33 and unnecessary or negative in 15. Haemodynamic instability and peritonitis were strong indicators of positive laparotomy; seven of 13 laparotomies for evisceration alone were negative, as were two of four for retained foreign bodies.


CONCLUSIONS
The laparotomy rate fell from 78.5 to 21.4 per cent over 25 years. The rate of unnecessary or negative laparotomy did not change. Isolated evisceration and retained foreign body remain relative indications.
Clarke
S C E
SC
Department of General and Vascular Surgery, Gartnavel General Hospital, 1053 Great Western Road, Glasgow G12 0YN, UK.
Stearns
A T
AT
Payne
C
C
McKay
A J
AJ
D000007:Abdominal Injuries / Q000209:etiology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D003952:Diagnostic Imaging / Q000379:methods; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D007813:Laparotomy / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D017410:Practice Guidelines as Topic; D014950:Wounds, Penetrating / Q000209:etiology / Q000601:surgery*