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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
PubMed
Summary
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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.

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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.