Clinical surgery-AmericanLocal wound exploration remains a valuable triage tool for the evaluation of anterior abdominal stab wounds
Section snippets
Methods
Patients sustaining penetrating trauma at our American College of Surgeons–verified level I trauma center over a 3-year period were reviewed. AASW were defined as stab wounds between the costal margins, inguinal ligaments, and bilateral anterior axillary lines. Patients with thoracoabdominal, back, or flank wounds were excluded because diagnostics or interventions might be different. The management practice at our institution is directed by a LWE/DPL algorithm (Fig. 1). The technique of LWE has
Patient demographics
During the study period, 2,080 patients were evaluated for penetrating trauma, of which 192 sustained AASW. The majority (89%) were men, with a mean age of 32 ± .9 years. Forty patients underwent emergent surgery, 139 patients followed our LWE/DPL algorithm, and 13 patients underwent alternate management (Fig. 2). A total of 104 (54%) patients had a single stab wound whereas the remainder had multiple wounds.
LWE
Of the 139 patients undergoing LWE, 56 (40%) had no evidence of fascial penetration
Comments
In the past decade, there have been a number of reports advocating the nonsurgical management of penetrating trauma. The majority addressed gunshot8, 9, 10, 11 or stab wounds to the back or flank.12, 13, 14 Clearly, these mechanisms of injury differ from penetrating trauma to the anterior abdomen. Few reports in the past decade have addressed the diagnostic dilemma of determining which patients with AASW have intra-abdominal injuries mandating laparotomy. The goal of evaluation in the ED is
References (29)
Indications for operation in abdominal trauma
Am J Surg
(1960)- et al.
Selective clinical management of anterior abdominal stab wounds
Am J Surg
(2004) - et al.
The efficacy of abdominal examination in penetrating abdominal trauma
Injury
(1999) - et al.
Five hundred open taps or lavages in patients with abdominal stab wounds
Am J Surg
(1984) - et al.
Practice management guidelines for nonoperative management of penetrating abdominal traumaEAST guidelines
Evaluation of peritoneal lavage and local exploration in lower chest and abdominal stab wounds
J Trauma
(1977)- et al.
Stab wounds of the anterior abdomenAnalysis of a management plan using local wound exploration and quantitative peritoneal lavage
Ann Surg
(1983) - et al.
The evolution of abdominal stab wounds management
J Trauma
(1980) - et al.
Technique for diagnostic peritoneal lavage
JACEP
(1979) - et al.
Peritoneal lavage enzyme determinations following blunt and penetrating abdominal trauma
J Trauma
(1991)