title: Management guidelines for penetrating abdominal trauma.
abstract: BACKGROUND
  The optimal management of patients with penetrating abdominal injuries has been debated for decades, since mandatory laparotomy (LAP) gave way to the concept of "selective conservatism."
  
  
  METHODS
  A comprehensive literature review was performed and summarized.
  
  
  RESULTS
  A proposed management guideline for patients with penetrating abdominal trauma was created.
  
  
  CONCLUSIONS
  Indications for immediate laparotomy (LAP) include hemodynamic instability, evisceration, peritonitis, or impalement. Selective nonoperative management of stable, asymptomatic patients has been demonstrated to be safe. Adjunctive diagnostic testing-ultrasonography, computed tomography, local wound exploration, diagnostic peritoneal lavage, laparoscopy-is often used in an attempt to identify significant injuries requiring operative management. However, prospective studies indicate that these tests frequently lead to nontherapeutic LAP, and are not cost-effective.
authors.affiliation: Department of Surgery, Denver Health Medical Center/University of Colorado, 777 Bannock Street, MC 0206, Denver, 80204-4507, CO, USA, walt@biffl.com.
authors.forename: Walter L
authors.initials: WL
authors.lastname: Biffl
authors.forename: Ari
authors.initials: A
authors.lastname: Leppaniemi
mesh_terms: D000007:Abdominal Injuries / Q000209:etiology / Q000628:therapy*; D000465:Algorithms; D000066491:Clinical Decision-Making; D003952:Diagnostic Imaging; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D010533:Peritoneal Lavage; D010538:Peritonitis / Q000209:etiology / Q000628:therapy; D014950:Wounds, Penetrating / Q000150:complications / Q000628:therapy*