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Indications for an Immediate Laparotomy in Patients with Abdominal Stab Wounds  

Kim, Hyeong Ju (Departments of Emergency Medicine, Masan Samsung Hospital, Sungkyunkwan University School of Medicine)
Hwang, Seong Youn (Departments of Emergency Medicine, Masan Samsung Hospital, Sungkyunkwan University School of Medicine)
Choi, Young Cheol (Departments of Surgery, Masan Samsung Hospital, Sungkyunkwan University School of Medicine)
Publication Information
Journal of Trauma and Injury / v.20, no.2, 2007 , pp. 106-114 More about this Journal
Abstract
Purpose: There is little controversy that a classic indication such as hemodynamic instability or any sign of peritoneal irritation requires an immediate laparotomy in the management of abdominal stab wounds. However, omental herniation or bowel evisceration as an indication for an immediate laparotomy is controversial. The purpose of this study was to evaluate the significance of these factors as indications for an immediate laparotomy. Methods: The medical records of 98 consecutive abdominal stab wounds patients admitted to the Emergency Center of Masan Samsung Hospital from January 2000 to December 2006 were carefully examined retrospectively. Using multivariate logistic regression analysis, thirty-nine factors, including the classic indication and intraabdominal organ evisceration, were evaluated and were found to be associated with a need for a laparotomy. Also, the classic indication was compared with a new indication consisting of components of the classic indication and intra-abdominal organ evisceration by constructing a contingency table according to the need for a laparotomy. Results: Multivariate logistic regression analysis revealed any sign of peritoneal irritation, base deficit, and age to be significant factors associated with the need for a laparotomy (p<0.05). The sensitivity, specificity, and accuracy rates of the classic indication were 98.6%, 72.0%, and 91.8%, respectively, and those of the new indication were 93.2%, 84.0%, and 90.8%, respectively. The differences in those rates between the above two indications were not significant. Conclusion: Intra-abdominal organ evisceration was not a significant factor for an immediate laparotomy. Moreover, the new indication including intra-abdominal organ evisceration was not superior to the classic indication. Therefore, in the management of abdominal stab wounds, the authors suggest that an immediate laparotomy should be performed on patients with hemodynamic instability or with any sign of peritoneal irritation.
Keywords
Stab wounds; Evisceration; Laparotomy; Abdomen;
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1 Shaftan GW. Indications for operation in abdominal trauma. Am J Surg 1960;99:657-64   DOI   ScienceOn
2 Shaftan GW. Selective conservatism in penetrating abdominal trauma. J Trauma 1969;9:1026-8   DOI   PUBMED
3 Leppaniemi AK, Voutilainen PE, Haapiainen RK. Indications for early mandatory laparotomy in abdominal stab wounds. Br J Surg 1999;86:76-80   DOI   PUBMED   ScienceOn
4 Robin AP, Andrews JR, Lange DA, Roberts RR, Moskal M, Barrett JA. Selective management of anterior abdominal stab wounds. J Trauma 1989;29:1684-9   DOI   PUBMED
5 Burnweit CA, Thal ER. Significance of omental eviceration in abdominal stab wounds. Am J Surg 1986;152:670-3   DOI   PUBMED   ScienceOn
6 McFarlane MEC. Non-operative management of stab wounds to the abdomen with omental evisceration. J R Coll Surg Edinb 1996;41:239-40   PUBMED
7 Medina M, Ivatury RR, Stahl WM. Omental evisceration through an abdominal stab wound: is exploratory laparotomy mandatory? Can J Surg 1984;27:399-401   PUBMED
8 Chiu WC, Shanmuganathan K, Mirvis SE, Scalea TM. Determining the need for laparotomy in penetrating torso trauma: A prospective study using triple-contrast enhanced abdominopelvic computed tomography. J Trauma 2001;51:860-9   DOI   ScienceOn
9 Granson MA, Donovan AJ. Abdominal stab wound with omental evisceration. Arch Surg 1983;118:57-9   DOI   PUBMED   ScienceOn
10 Demetriades D, Rabinowitz B. Selective conservative management of penetrating abdominal wounds: A prospective study. Br J Surg 1984;71:92-4   DOI   ScienceOn
11 Nagy K, Roberts R, Joseph K, An G, Barrett J. Evisceration after abdominal stab wounds: Is laparotomy required? J Trauma 1999;47:622-6   DOI   ScienceOn
12 Sugrue M, Balogh Z, Lynch J, Bardsley J, Sisson G, Weigelt J. Guidelines for the management of haemodynamically stable patients with stab wounds to the anterior abdomen. ANZ J Surg 2007;77:614-20   DOI   ScienceOn
13 Minaker KL. Common clinical sequence of aging. In: Goldman L, Ausiello D eds. Cecil Textbook of Medicine. 22nd ed. Philadelphia: W.B. Saunders; 2004:105-11
14 Moore EE, Marx JA. Penetrating abdominal wounds: Rationale for exploratory laparotomy. JAMA 1985;253:2705-8   DOI   ScienceOn
15 Sirinek KR, Page CP, Root HD, Levine BA. Is exploratory celiotomy necessary for all patients with truncal stab wounds? Arch Surg 1990;125:844-8   DOI   PUBMED   ScienceOn
16 Demetriades D, Rabinowitz B. Indications for operation in abdominal stab wounds: A prospective study of 651 patients. Ann Surg 1987;205:129-32   DOI   PUBMED   ScienceOn
17 Arikan S, Kocakusak A, Yucel AF, Adas G. A prospective comparison of the selective observation and routine exploration methods for penetrating abdominal stab wounds with organ or omentum evisceration. J Trauma 2005;58:526-32   DOI   ScienceOn
18 Alzamel HA, Cohn SM. When is it safe to discharge asymptomatic patients with abdominal stab wounds? J Trauma 2005;58:523-5   DOI   ScienceOn