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Abdominal stab wound protocol: prospective study documents applicability for widespread use
A S Rosemurgy1, M H Albrink, S M Olson
1Department of Surgery, University of South Florida, Tampa.
The American Surgeon
|February 1, 1995
Summary
Selective management of abdominal stab wounds is safe. A new protocol reduced nontherapeutic celiotomies (NTC) by using paracentesis and peritoneal lavage, avoiding unnecessary exploratory surgery in many patients.
Area of Science:
- Trauma Surgery
- Surgical Protocols
- Emergency Medicine
Background:
- Exploratory celiotomy for abdominal stab wounds often resulted in nontherapeutic outcomes.
- A need existed to reduce unnecessary surgical interventions for abdominal trauma.
Purpose of the Study:
- To evaluate a protocol for selective management of abdominal stab wounds.
- To decrease the rate of nontherapeutic celiotomies (NTC) in patients with fascial penetration.
Main Methods:
- Prospective study of stable adult patients with abdominal stab wounds violating anterior abdominal wall fascia.
- Utilized paracentesis and peritoneal lavage selectively in patients without prior abdominal surgery.
- Evisceration was managed with reduction and lavage.
Main Results:
- Fascial penetration occurred in 72 patients; 46 underwent celiotomy.
- The protocol successfully avoided exploration in over one-third of patients with fascial penetration.
- The nontherapeutic celiotomy rate was 17% (11/65) for patients with fascial penetration, excluding those with prior abdominal surgery.
Conclusions:
- Selective management of abdominal stab wounds, incorporating paracentesis and lavage, is safe and effective.
- This approach significantly reduces nontherapeutic celiotomy rates.
- Careful patient selection and diagnostic techniques can optimize surgical decision-making in abdominal trauma.