ORIGINAL ARTICLE

Unnecessary laparotomy by using physical examination and different diagnostic modalities for penetrating abdominal stab wounds

C Ertekin¹, H Yanar¹, K Taviloglu¹, R Güloglu¹, O Alimoglu²

¹ Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
² Department of General Surgery, Vakif Gureba Training Hospital, Istanbul, Turkey

Correspondence to:
Correspondence to:
Dr C Ertekin
Istanbul University, Istanbul Faculty of Medicine, Trauma and Emergency Medicine Service, 34390, Çapa, Istanbul; cemalettin{at}ertekin.info

Background: The modern management of penetrating abdominal trauma has decreased the incidence of unnecessary laparotomy by using selective non-operative management protocols. However, the real benefits of physical examination and different diagnostic methods are still unclear.

Methods: From January 2000 to April 2003, we prospectively collected data on 117 patients with penetrating stab wounds to the thoracoabdominal, anterior abdominal, and back regions who had non-operative management. Clinical examination was the primary tool to differentiate those patients requiring operation. Findings of physical examination, ultrasound, computed tomography, endoscopy, echocardiography, diagnostic peritoneal lavage, and diagnostic laparoscopy were reviewed. The number of therapeutic, non-therapeutic, and negative laparotomies were recorded.

Results: Non-operative management was successful in 79% of patients. There were 11 early (within 8 hours of admission) and 14 delayed (more than 8 hours after admission) laparotomies performed, depending on the results of various diagnostic procedures. Non-operative management failed in 21% of patients, and the rate of non-therapeutic laparotomy in early and delayed laparatomy groups was 9% and 14% respectively. There was no negative laparatomy.

Conclusions: The use of physical examination alone and/or together with different diagnostic methods allows reduction of non-therapeutic laparotomies and elimination of negative laparatomies.

Abbreviations: CT, computerised tomography; DL, diagnostic laparoscopy; DPL, diagnostic peritoneal lavage; IVP, intravenous pyelogram; US, ultrasound

Keywords: Stab wound; penetrating abdominal trauma; physical examination; diagnostic methods; non-operative management; unnecessary laparotomies

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