Nonoperative Management of Penetrating Injuries to the Abdomen

Abstract

Contemporary management of penetrating abdominal trauma includes potential nonoperative management in a select group of patients. Patients with hemodynamic instability or peritonitis after penetrating abdominal trauma require immediate laparotomy. Stable, evaluable patients without peritonitis, however, may be selected for a protocol of serial abdominal and laboratory examinations. Cross-sectional imaging is a useful adjunct for trajectory mapping, especially after gunshot wounds. Although many patients may be successfully managed without operation, a subset of patients selected for nonoperative management will develop clinical signs of intra-abdominal injury and required delayed laparotomy. Protocols of selective nonoperative management after penetrating abdominal trauma have been shown to be safe. The desire to avoid the morbidity of nontherapeutic laparotomy, however, must continue to be weighed against the risk of missed intra-abdominal injury and the institutional feasibility of strict adherence to a protocol of serial examinations.