Posterior abdominal stab wounds: role of CT evaluation

Stab wounds to the back present a diagnostic problem, since missed occult abdominal injuries can lead to serious morbidity. In a prospective study of 205 patients, the authors evaluated the usefulness of abdominal computed tomography (CT) in assessment of low-velocity penetrating injury to the back. CT results were classified into three groups. Category 1 included injuries limited to superficial subcutaneous tissue (n = 174); category 2, injuries to the retroperitoneal compartment (n = 18); and category 3, injuries within the peritoneal cavity (n = 13). Fifty patients underwent surgery, including 30 with category 1 injuries, nine with category 2 injuries, and eleven with category 3 injuries. CT categorization of injury, compared with surgical findings in these 50 patients, had a sensitivity of 85% and specificity of 93%. The CT interpretation was considered correct if it demonstrated peritoneal penetration or retroperitoneal injury potentially requiring surgery. The remaining 155 patients were managed nonoperatively, and none had late complications. Abdominal CT is a reliable diagnostic tool in the evaluation of penetrating injury to the back.