• Vassiliki Tsikitis, Walter L Biffl, Sarah Majercik, David T Harrington, and William G Cioffi.
• Division of Trauma and Surgical Critical Care, Rhode Island Hospital/Brown Medical School, 593 Eddy Street, APC 443, Providence, RI 02903, USA.
• Am. J. Surg. 2004 Dec 1;188(6):807-12.

BackgroundThe optimal management of clinically stable patients with anterior abdominal stab wounds (AASWs) is debated. We implemented a protocol of serial clinical assessments to determine the need for laparotomy. The purpose of this study was to determine whether the approach is safe and effective.MethodsRecords of patients sustaining AASWs from 1999 to 2003 were reviewed.ResultsSeventy-seven patients sustained AASWs. Twenty-five were taken directly to the operating room because of hypotension (5), evisceration (7), or peritonitis (15). Seventeen patients had diagnostic peritoneal lavage (DPL) for associated thoracoabdominal wounds and 5 had local wound exploration (LWE) off protocol. The remaining 30 patients were managed with serial clinical assessments and were discharged uneventfully.ConclusionPatients sustaining AASWs who present without hypotension, evisceration, or peritonitis may be managed safely under a protocol of serial clinical evaluations. This approach should be compared with LWE/DPL in a prospective, randomized multicenter trial.

31 keywords...

hide…