Surgical judgment in the management of abdominal stab wounds. Utilizing clinical criteria from a 10-year experience

A 10-year retrospective study of patients with stab wounds to the abdomen managed under a protocol of selective management has been performed. Patients were assessed on the basis of clinical presentation and physical examination, with minimal diagnostic studies. Peritoneal lavage was not utilized in the evaluation of the patients. Two hundred and nineteen such patients were identified. One hundred and eleven of these patients were treated nonoperatively. Ninety patients were treated by immediate laparotomy. Eighteen patients, initially observed, underwent delayed laparotomy. One patient, not explored despite clear-cut indications for laparotomy, died of sepsis, emphasizing the need for strict adherence to the stated protocol. The negative or unnecessary laparotomy rate was 7.8%. The false-negative examination rate was 5.5%. Overall mortality rate was 2.3%. The accuracy of careful clinical evaluation and observation is comparable to, or better than, any other method currently available to identify intra-abdominal injuries in patients with abdominal stab wounds. The study suggests that selective management of stab wounds of the abdomen may be safely practiced in a smaller community hospital.