Background
The impetus for selective nonoperative management comes largely from the significant rates of nontherapeutic laparotomies following penetrating trauma and the high incidence of complications accompanying nontherapeutic laparotomy. Multiple diagnostic modalities were introduced to select patients indicated for surgery. These modalities included serial clinical examination, focused assessment with sonography for trauma, triple-contrast computed tomography abdomen/pelvis, and finally diagnostic laparoscopy.
Patients and methods
Patients present to the emergency unit of KasrAlAiny University Hospitals with posterior abdominal-wall stab wounds. Hemodynamically stable patients with no abdominal signs of peritonitis are chosen. CT abdomen with oral, rectal, and IV contrast is done to exclude patients with no intraperitoneal or retroperitoneal organ injury requiring laparotomy. Patients are admitted under conservative management in the ward for at least 3 days. Patients who develop vital-sign derangement or peritonitis are explored.
Results
The mean age of the study population 29.02 ± 9.2 years. In total, 37 (92%) patients were successfully managed conservatively. Three (8%) patients were explored after developing hemodynamic instability. A colonic injury was found in one patient, bleeding from posterior abdominal wall was found in one patient, and one patient had a nontherapeutic laparotomy. The triple-contrast CT had a sensitivity of 100% (2/2), specificity of 76.3% (29/38), positive predictive value of 18.2% (2/11), negative predictive value of 100% (29/29), and accuracy of 77.5% (31/40). There was a statistically significant relation (=0.0167) between success of conservative management and CT findings.
Conclusion
Hemodynamically stable patients who presented with penetrating PASWs with no evisceration or signs of peritonitis can be managed conservatively when their triple-contrast CT images show no evidence of intraperitoneal or retroperitoneal organ injury requiring laparotomy.