Selective clinical management of anterior abdominal stab wounds
Vassiliki Tsikitis1, Walter L Biffl, Sarah Majercik
1Division of Trauma and Surgical Critical Care, Rhode Island Hospital/Brown Medical School, 593 Eddy Street, APC 443, Providence, RI 02903, USA.
Background:
The optimal management of clinically stable patients with anterior abdominal stab wounds (AASWs) is debated. We implemented a protocol of serial clinical assessments to determine the need for laparotomy. The purpose of this study was to determine whether the approach is safe and effective.
Methods:
Records of patients sustaining AASWs from 1999 to 2003 were reviewed.
Results:
Seventy-seven patients sustained AASWs. Twenty-five were taken directly to the operating room because of hypotension (5), evisceration (7), or peritonitis (15). Seventeen patients had diagnostic peritoneal lavage (DPL) for associated thoracoabdominal wounds and 5 had local wound exploration (LWE) off protocol. The remaining 30 patients were managed with serial clinical assessments and were discharged uneventfully.
Conclusion:
Patients sustaining AASWs who present without hypotension, evisceration, or peritonitis may be managed safely under a protocol of serial clinical evaluations. This approach should be compared with LWE/DPL in a prospective, randomized multicenter trial.
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