Penetrating Abdominal Injuries: A 10-Year Retrospective Analysis of 49 Patients at a German Trauma Center

BACKGROUND Penetrating abdominal injuries are rare in central Europe; therefore, most trauma surgeons have little experience in the treatment of these injuries. The optimal management of penetrating abdominal injuries remains debated. While immediate surgery is standard for unstable patients or those with peritonitis, bowel evisceration, or gunshot wounds, the treatment of stable patients is still controversial. This study aimed to assess the reliability of preoperative diagnostics compared to intraoperative findings. MATERIAL AND METHODS Forty-nine patients with penetrating abdominal injuries were admitted to our hospital from 2006 to 2015. Seven were excluded due to emergency surgery without preoperative computed tomography (CT) scans. CT findings were compared with intraoperative surgical findings to calculate sensitivity and specificity. RESULTS The average age was 39.9 years; 83% were male. Most injuries were stab wounds (83%). Most injuries resulted from interpersonal violence (64.3%), whereas 15 cases (35.7%) were due to failed suicide attempts. In 69% of cases, CT and surgical findings matched. CT underestimated injuries in 69.2% of discordant cases. Sensitivity, specificity, and accuracy were 52.6%, 82.6%, and 57.4%, respectively. Laparotomy revealed no intra-abdominal injury in 45.2%. CONCLUSIONS Conservative management is justified in stable patients with negative CT findings, but requires close monitoring to avoid delayed intervention and unnecessary surgery. Nearly 50% of laparotomies could have been avoided, given that no intra-abdominal injuries were identified in those patients, and their in-hospital stay was prolonged.