Introduction: The approach to anterior abdominal penetrating wounds remains controversial. Military experience during this century led to a policy of mandatory exploration for all penetrating abdominal wounds, which resulted in improved survival. In civilian experience, stab wounds that strike the anterior abdominal wall less often penetrate the peritoneal cavity and even with confirmed penetration, often do not result in serious intra-abdominal injury. The appropriate strategy as such is to diagnose and treat stab wounds, which have resulted in serious intro-abdominal injury, while keeping negative laparotomy, with its associated morbidity, to a minimum. There is a growing body of evidence that a selective approach based on careful clinical evaluation best serves this purpose and does not incur undue risk due to missed injuries.

Objective: To evaluate the safety of a policy of selective non-operative management either with local wound exploration or serial physical examinations in patients with anterior abdominal stab wounds.

Patients and Methods: During the period between September 1998 and January 2001, 57 patients with anterior abdominal stab wounds presented to accident and emergency unit in Ain Shams University Hospitals. Seven patients were operated upon on emergency basis and excluded from the present work. The remaining 50 patients were divided into two equal groups. The patients in the first group (A) were clinically observed, including those with eviscerated omentum and air under the diaphragm. Patients in the other group (B) underwent wound exploration under local anesthesia in the operative theater, with the intention to do laparotomy for those with peritoneal penetration.

Results: Laparotomy was mandated in 5 patients (20%) in group A. Positive laparotomy was obtained in 4 patients (16%). The positive predictive value for detection of stab wounds necessitating positive laparotomy applying the method of solo physical observation was 80%. There was no morbidities or mortalities associated with the "delayed" positive laparotomies in this group. The peritoneum was violated in 15 patients (60%) in group B. Laparotomy was conducted in these 15 patients, but only 4 (16%) showed lesions for which the procedure was truly indicated. The positive predictive value for detection of stab wounds necessitating laparotomy using local wound exploration was 26.7%. The mean hospital stay was 46 and 73 hours for group A and B, respectively. This was statistically significant with p<0.05.

Conclusion: Selective non-operative management in the form of local wound exploration and serial physical examination is a safe method for managing patients with anterior abdominal stab wounds. It reduces significantly the rate of unnecessary laparotomy and hospital stay especially if both methods are used in combination.