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Prediction of Injury Caused by Penetrating Wounds to the Abdomen, Flank, and Back

Prediction of Injury Caused by Penetrating Wounds to the Abdomen, Flank, and Back Abstract • Controversy about the appropriate evaluation of penetrating abdominal, flank, and back injuries prompted this retrospective review of 311 patients at an urban level I trauma center over 5 years. Seventy-five (24%) patients sustained gunshot wounds to the abdomen. All patients with gunshot wounds underwent exploratory laparotomy; results of 67 laparotomies (89%) were positive. Of 236 patients sustaining stab wounds (140 abdominal wounds, 51 flank wounds, 26 back wounds, and 19 wounds to multiple sites), 147 were treated according to a selective protocol, based on results of physical examination, wound exploration, peritoneal lavage, and ancillary diagnostic studies. No injuries were found at celiotomy in three (2%) of these 147 patients. One false-negative result of evaluation of a flank wound occurred. Significant injuries were found in 13 patients (68%) with stab wounds to multiple sites, 61 patients (44%) with abdominal stab wounds, 15 patients (29%) with flank stab wounds, and four patients (15%) with back stab wounds. Mandatory exploration of gunshot wounds is justified. Physical findings of intra-abdominal injury or positive results of peritoneal lavage identify stab wound victims likely to benefit from surgical exploration. A policy of mandatory observation or routine celiotomy for treatment of stab wounds is not justified. (Arch Surg. 1991;126:962-966) References 1. Lowe RF, Boyd DR, Folk FA, Baker RJ. The negative laparotomy for abdominal trauma . J Trauma . 1972;12:853-860.Crossref 2. Liu M, Shoemaker WC, Kram HB, Harrier HD. Design and prospective evaluation of an algorithm for penetrating truncal injuries . Crit Care Med . 1988;16:1191-1198.Crossref 3. Merlotti GJ, Marcet E, Sheaff CM, Dunn R, Barrett JA. Use of peritoneal lavage to evaluate abdominal penetration . J Trauma . 1985;25:228-231.Crossref 4. Edwards J, Gaspard DJ. Visceral injury due to extraperitoneal gunshot wounds . Arch Surg . 1974;108:865-866.Crossref 5. Merlotti GJ, Dillon BC, Lange DA, Robin AP, Barrett JA. Peritoneal lavage in penetrating thoraco-abdominal trauma . J Trauma . 1988;28:17-23.Crossref 6. Zubowski R, Nallathambi M, Ivatury R, Stahl W. Selective conservatism in abdominal stab wounds: the efficacy of serial physical examination . J Trauma . 1988;28:1665-1668.Crossref 7. Thal ER. Peritoneal lavage: reliability of RBC count in patients with stab wounds to the chest . Arch Surg . 1984;119:579-584.Crossref 8. Madden MR, Paull DE, Finkelstein JL, et al. Occult diaphragmatic injury from stab wounds to the lower chest and abdomen . J Trauma . 1989;29:292-298.Crossref 9. Myer DM, Thal ER, Weigelt JA, Redman HC. The role of abdominal CT in the evaluation of stab wounds to the back . J Trauma . 1989;29:1226-1230.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Prediction of Injury Caused by Penetrating Wounds to the Abdomen, Flank, and Back

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1991.01410320044004
Publisher site
See Article on Publisher Site

Abstract

Abstract • Controversy about the appropriate evaluation of penetrating abdominal, flank, and back injuries prompted this retrospective review of 311 patients at an urban level I trauma center over 5 years. Seventy-five (24%) patients sustained gunshot wounds to the abdomen. All patients with gunshot wounds underwent exploratory laparotomy; results of 67 laparotomies (89%) were positive. Of 236 patients sustaining stab wounds (140 abdominal wounds, 51 flank wounds, 26 back wounds, and 19 wounds to multiple sites), 147 were treated according to a selective protocol, based on results of physical examination, wound exploration, peritoneal lavage, and ancillary diagnostic studies. No injuries were found at celiotomy in three (2%) of these 147 patients. One false-negative result of evaluation of a flank wound occurred. Significant injuries were found in 13 patients (68%) with stab wounds to multiple sites, 61 patients (44%) with abdominal stab wounds, 15 patients (29%) with flank stab wounds, and four patients (15%) with back stab wounds. Mandatory exploration of gunshot wounds is justified. Physical findings of intra-abdominal injury or positive results of peritoneal lavage identify stab wound victims likely to benefit from surgical exploration. A policy of mandatory observation or routine celiotomy for treatment of stab wounds is not justified. (Arch Surg. 1991;126:962-966) References 1. Lowe RF, Boyd DR, Folk FA, Baker RJ. The negative laparotomy for abdominal trauma . J Trauma . 1972;12:853-860.Crossref 2. Liu M, Shoemaker WC, Kram HB, Harrier HD. Design and prospective evaluation of an algorithm for penetrating truncal injuries . Crit Care Med . 1988;16:1191-1198.Crossref 3. Merlotti GJ, Marcet E, Sheaff CM, Dunn R, Barrett JA. Use of peritoneal lavage to evaluate abdominal penetration . J Trauma . 1985;25:228-231.Crossref 4. Edwards J, Gaspard DJ. Visceral injury due to extraperitoneal gunshot wounds . Arch Surg . 1974;108:865-866.Crossref 5. Merlotti GJ, Dillon BC, Lange DA, Robin AP, Barrett JA. Peritoneal lavage in penetrating thoraco-abdominal trauma . J Trauma . 1988;28:17-23.Crossref 6. Zubowski R, Nallathambi M, Ivatury R, Stahl W. Selective conservatism in abdominal stab wounds: the efficacy of serial physical examination . J Trauma . 1988;28:1665-1668.Crossref 7. Thal ER. Peritoneal lavage: reliability of RBC count in patients with stab wounds to the chest . Arch Surg . 1984;119:579-584.Crossref 8. Madden MR, Paull DE, Finkelstein JL, et al. Occult diaphragmatic injury from stab wounds to the lower chest and abdomen . J Trauma . 1989;29:292-298.Crossref 9. Myer DM, Thal ER, Weigelt JA, Redman HC. The role of abdominal CT in the evaluation of stab wounds to the back . J Trauma . 1989;29:1226-1230.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Aug 1, 1991

References