Local wound exploration remains a valuable triage tool for the evaluation of anterior abdominal stab wounds

C Clay Cothren, Ernest E Moore, Frank A Warren, Jeffry L Kashuk, Walter L Biffl, Jeffrey L Johnson
American Journal of Surgery 2009, 198 (2): 223-6

BACKGROUND: Recent guidelines do not support local wound exploration (LWE) or diagnostic peritoneal lavage (DPL) in the evaluation of patients with anterior abdominal stab wounds (AASWs), favoring computed tomography scanning or serial examinations. In patients without immediate indications for laparotomy, we hypothesized that LWE/DPL would identify patients requiring surgery while limiting unnecessary hospital admissions.

METHODS: Patients sustaining penetrating trauma at our level I trauma center over a 3-year period were reviewed.

RESULTS: During the study period, 139 patients with AASW followed our LWE/DPL algorithm. Fifty-six patients had LWE without fascial penetration: 46 were discharged immediately, 10 required admission. Fifty-eight patients had fascial penetration on LWE but negative DPL: 37 were observed for less than 24 hours, 19 were observed for more than 24 hours, and 2 patients developed peritonitis requiring exploration. Twenty-five patients had positive LWE/DPL: 13 had therapeutic laparotomy, 12 had nontherapeutic laparotomy.

CONCLUSIONS: Only 11% of patients with AASWs without overt indication for laparotomy require surgical care. LWE remains a valid method to exclude intra-abdominal injury and to eliminate hospitalization in more than one third of AASW patients.

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