Penetrating abdominal stab wounds – current practice and recommendations

Abstract

This retrospective study reviews current practice in managing penetrating abdominal stab wounds in our centre and evaluates patients who can be safely managed non-operatively. The records of patients admitted to Rashid Hospital with isolated abdominal stab injuries from January 2011 to December 2015 were reviewed. We reviewed the patients’ demographic data, clinical findings, diagnostic tests and surgical interventions. Patients were eligible for inclusion if they had a penetrating stab injury and fulfilled the criteria for conservative management (i.e. were haemodynamically stable, with localized tenderness and no evisceration). Patients were excluded if they were haemodynamically unstable or had evisceration and generalized tenderness. A total of 66 patients with abdominal stab wounds were admitted between January 2011 and December 2015; 44 of these had penetrating injuries. The mean age of the patients was 28 years; 62 (94%) were men and four (6%) were women. A total of 29 patients fulfilled the inclusion criteria, but only six were treated fully conservatively. Twenty-three (35%) patients underwent surgery; 13 (57%) procedures were non-therapeutic and 10 (43%) were therapeutic. Selective non-operative management for stable patients without signs of peritonitis is an effective tool for decreasing the number of unnecessary laparotomies, but this should be practised in a specialized trauma centre and performed by experienced clinicians (preferably by the same team). The use of triple-contrast abdominal computerized tomography can reduce the rate of negative findings at laparotomy. Diagnostic laparoscopy is safe and decreases both the requirement for non-therapeutic laparotomy and length of hospital stay.