Selection of patients with abdominal stab wounds for laparotomy

The roles of local wound exploration (LWE) and peritoneal lavage (PL) in the selective management of stab wounds to the lower chest and abdomen were evaluated prospectively in 53 patients. Twenty-four patients underwent immediate laparotomy for obvious clinical signs of intra-abdominal injuries. Twenty-nine patients with evidence of anterior abdominal fascia penetration or equivocal LWE had PL before laparotomy. Operative findings were correlated with the preoperative assessment of LWE and PL. Twenty patients in this group had intra-abdominal injuries. All patients with positive PL were found to have an intra-abdominal injury. Six patients with a negative PL and a positive LWE had visceral injuries. Three of these injuries were considered significant with an overall false negative PL of 15%. Laparotomy performed on the basis of LWE resulted in nine patients (31%) having an unnecessary laparatomy. Careful physical examination, the results of local wound exploration, and peritoneal lavage should be considered in selecting patients with abdominal stab wound for laparotomy.