Management of penetrating abdominal and thoraco-abdominal wounds: A retrospective study of 186 patients.
This is a single center retrospective review of abdominal or abdomino-thoracic penetrating wounds treated between 2004 and 2013 in the gastrointestinal and emergency unit of the university hospital of Grenoble, France. This study did not include patients who sustained blunt trauma or non-traumatic wounds, as well as patients with penetrating head and neck injury, limb injury, ano-perineal injury, or isolated thoracic injury above the fifth costal interspace. In addition, we also included cases that were reviewed in emergency department morbidity and mortality conferences during the same period. Mortality was 5.9% (11/186 patients). Mean age was 36 years (range: 13-87). Seventy-eight percent (145 patients) suffered stab wounds. Most patients were hemodynamically stable or stabilized upon arrival at the hospital (163 patients: 87.6%). Six resuscitative thoracotomies were performed, five for gunshot wounds, one for a stab wound. When abdominal exploration was necessary, laparotomy was chosen most often (78/186: 41.9%), while laparoscopy was performed in 46 cases (24.7%), with conversion to laparotomy in nine cases. Abdominal penetration was found in 103 cases (55.4%) and thoracic penetration in 44 patients (23.7%). Twenty-nine patients (15.6%) had both thoracic and abdominal penetration (with 16 diaphragmatic wounds). Suicide attempts were recorded in 43 patients (23.1%), 31 (72.1%) with peritoneal penetration. Two patients (1.1%) required operation for delayed peritonitis, one who had had a laparotomy qualified as "negative", and another who had undergone surgical exploration of his wound under general anesthesia. In conclusion, management of clear-cut or suspected penetrating injury represents a medico-surgical challenge and requires effective management protocols.
Département de Chirurgie Digestive et de l'Urgence, CHU de Grenoble, 38043 Grenoble cedex 09, France. Electronic address: sandrinebarbois@yahoo.fr.
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Barbois
Département de Chirurgie Digestive et de l'Urgence, CHU de Grenoble, 38043 Grenoble cedex 09, France.
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Abba
Département de Chirurgie Thoracique et Endocrinienne, CHU de Grenoble, 38043 Grenoble cedex 09, France.
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Guigard
Département Scientifique-DRCI, CHU de Grenoble, 38043 Grenoble cedex 09, France.
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Quesada
Département de Chirurgie Thoracique et Endocrinienne, CHU de Grenoble, 38043 Grenoble cedex 09, France.
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Pirvu
Département de Chirurgie Digestive et de l'Urgence, CHU de Grenoble, 38043 Grenoble cedex 09, France.
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Waroquet
Département de Chirurgie Digestive et de l'Urgence, CHU de Grenoble, 38043 Grenoble cedex 09, France.
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Reche
Département de Chirurgie Digestive et de l'Urgence, CHU de Grenoble, 38043 Grenoble cedex 09, France.
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Risse
Département de Réanimation et Déchoquage, CHU de Grenoble, 38043 Grenoble cedex 09, France.
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Bouzat
Département de Radiologie et d'Imagerie Médicale, CHU de Grenoble, 38043 Grenoble cedex 09, France.
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Thony
Département de Chirurgie Digestive et de l'Urgence, CHU de Grenoble, 38043 Grenoble cedex 09, France.
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Arvieux
D000007:Abdominal Injuries / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000601:surgery*; D013908:Thoracotomy; D014950:Wounds, Penetrating / Q000601:surgery*
Abdominal trauma; Epidemiology; Penetrating trauma; Thoracic trauma; Thoraco-abdominal trauma