Feb 23, 1999

Indications for early mandatory laparotomy in abdominal stab wounds

The British Journal of Surgery
A K LeppäniemiR K Haapiainen


Patients with an abdominal stab wound presenting with shock, peritonitis or evisceration are usually subjected to early laparotomy, although very few studies have been done to validate the criteria. In a retrospective study of 209 consecutive patients with stab wounds of the anterior abdomen, flank or lower chest, 23 clinical and radiological criteria were evaluated for their accuracy in predicting the presence of significant abdominal organ injury. Overall, 89 patients (43 per cent) had a significant abdominal injury. The criteria with the highest positive predictive values for significant injury were: signs of continuing haemorrhage in initially normotensive patients (86 per cent), shock on admission (83 per cent) and generalized peritonitis (81 per cent). No positive direct or indirect signs of peritoneal penetration including omental evisceration, extraluminal air on plain radiography, or free peritoneal fluid on abdominal ultrasonography were independent predictors of significant injury. Signs of major internal haemorrhage or generalized peritonitis are reliable criteria by themselves for early laparotomy. Peritoneal penetration is a poor indicator of significant organ injury and warrants direct organ-specific evaluation, ...Continue Reading

Mentioned in this Paper

Wounds, Stab
Hemorrhagic Septicemia
Logistic Regression
False Positive Reactions
Panniculitis, Peritoneal
Trauma to the Abdomen
Retrospective Studies
Decision Making, Shared

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