Selective conservatism in penetrating abdominal wounds: a continuing reappraisal

Our experience with 829 patients with penetrating abdominal trauma treated in an Adult Trauma Service over 8 1/2 years managed by "selective conservatism" is reviewed, and 207 additional patients with blunt abdominal trauma handled in the same fashion were also studied. This pattern of management prompted exploratory celiotomy in only 29% of stab wounds and 54% of gunshot wounds. Overall mortality for penetrating abdominal wounds, including patients moribund on admission, was 2.5%. Overall mortality was 19.3% for blunt abdominal trauma. There were no deaths or errors in management in those patients definitively selected for nonoperative management. The philosophy of using specific objective indications for abdominal exploration in both penetrating and blunt abdominal trauma, especially when bolstered by routine abdominal paracentesis and lavage, is safe and reliable, and is adaptable to all clinical facilities.