Nonoperative management of anterior thoracoabdominal stab wounds in selected patients.

OBJECTIVES: Nowadays, use of selective nonoperative management has decreased the incidence of nontherapeutic laparotomies in patients with anterior thoracoabdominal stab wounds. The safety of selective nonoperative management was investigated in these patients, not requiring emergency laparotomy.

PATIENTS AND METHODS: Patients referred to the Tabriz Imam Reza Hospital with anterior thoracoabdominal stab wounds were studied from August 2008 to 2010. The hemodynamically unstable patients, those with evidence of peritoneal irritation or with organ evisceration, underwent an emergency laparotomy. For other patients, diagnostic peritoneal lavage (DPL) was used and patients with positive results were operated. Patients with negative DPL results underwent serial physical and laboratory examinations.

RESULTS: A total of 204 patients were studied. Sixty-two cases (30.4%) had emergency operations, with 12 (19.4%) cases of nontherapeutic laparotomies. On the basis of DPL results in 142 (69.6%) patients, laparotomy was carried out in another 18 (12.7%) cases with a nontherapeutic result in eight (5.6%) cases. Finally, 124 (60.8%) patients were left for further observation and serial physical and laboratory examinations. Accordingly, five (4%) patients needed delayed laparotomy without any serious complications due to the delayed operation. The length of hospital stay and nontherapeutic laparotomies in our study were lower than mandatory laparotomy management and also, there were no significant complications or mortalities within the 90 days follow-up period.

CONCLUSION: This study showed that the proposed approach of selective nonoperative management in patients with anterior thoracoabdominal stab wounds is safe, feasible, and probably cost-effective.