Management guidelines for penetrating abdominal trauma.
OBJECTIVE
Patients with penetrating abdominal trauma are at risk of harboring life-threatening injuries. Many patients are in need of emergent operative intervention. However, there are clearly patients who can be safely managed nonoperatively. This review evaluates the literature to identify management guidelines for patients with penetrating abdominal trauma.


RESULTS
Accumulating evidence supports nonoperative management of patients with stab wounds to the thoracoabdominal region, the back, flank, and anterior abdomen. Furthermore, select patients with gunshot wounds can be safely managed nonoperatively.


CONCLUSIONS
Shock, evisceration, and peritonitis warrant immediate laparotomy following penetrating abdominal trauma. Thoracoabdominal stab wounds should be further evaluated with chest X-ray, ultrasonography, and laparoscopy or thoracoscopy. Wounds to the back and flank should be imaged with CT scanning. Anterior abdominal stab wound victims can be followed with serial clinical assessments. The majority of patients with gunshot wounds are best served by laparotomy; however, select patients may be managed expectantly.
Biffl
Walter L
WL
Department of Surgery, Denver Health Medical Center/University of Colorado, Denver, Colorado 80204-4507, USA. walter.biffl@dhha.org
Moore
Ernest E
EE
D000007:Abdominal Injuries / Q000150:complications / Q000601:surgery / Q000628:therapy*; D006801:Humans; D010538:Peritonitis / Q000209:etiology / Q000628:therapy; D017410:Practice Guidelines as Topic; D012769:Shock / Q000209:etiology / Q000628:therapy; D014057:Tomography, X-Ray Computed; D015599:Trauma Severity Indices; D014950:Wounds, Penetrating / Q000150:complications / Q000601:surgery / Q000628:therapy*