Non-operative management of isolated single abdominal stab wound: is it safe?

This is a retrospective review of prospectively collected data on our hospital, a Level 1 trauma centre, where stable patients with single abdominal stab wounds are considered for non-operative (conservative) management if they fulfil the criteria with the aid of computed tomography. The aim is to review our current approach in managing these patients.

Patients' data were obtained from January 2005 to June 2016. All injuries classed as assault or self-harm by sharp object in Injury Severity Score body region 4 were included. Patients were excluded from this study if they had haemodynamic instability, peritonism, significant findings on computed tomography, intoxicated, sustained head injury, sedated and intubated or evisceration of bowel, impalement of the stabbed object, potential thoraco-abdominal injury and multiple stab wounds. The patients were divided into non-operative and delayed operative groups for analysis.

One hundred and sixty-six of the 313 patients who presented with abdominal stab wounds matched our criteria. One hundred and sixty-three patients (98.2%) from the non-operative group were discharged without complications following period of observation, while three patients underwent operative intervention following trial of non-operative management. The mean length of stay for the successful non-operative group and the group which required delayed operative intervention were 2.8 and 6 days, respectively. No morbidity or mortality was recorded in either group.

Our observational study showed that in a Level 1 trauma centre, patients with single anterior abdominal stab wound and normal vital signs can potentially be safely managed with non-operative approach provided that these patients are cooperative for close observation.