Penetrating posterior abdominal trauma

Wounds of the back and flank pose a risk of injury to retroperitoneal structures which may be missed on physical examination. Recently, a selective approach to these wounds has been advocated. In order to document the incidence, management, and outcome of patients with penetrating wounds of the back and flank, we undertook a retrospective review of patients admitted over the past 5 years. Twenty-nine patients with penetrating posterior abdominal wounds were reviewed. There were 17 stab wounds and 12 gunshot wounds. All six patients who exhibited haemodynamic instability or abnormalities on physical examination underwent emergency laparotomy. The remaining 23 patients were admitted for observation. All patients underwent physical examination, abdominal radiographs, and urinalysis. Nine underwent IVP. Eight patients had abdominal CTs. No peritoneal lavages were performed. There were no missed injuries, no deaths and no delayed operations. There were two complications in the operative group, and one liver abscess in the nonoperative group. We conclude that selective management is a safe approach in penetrating posterior abdominal trauma without obvious indications for laparotomy.