Penetrating Abdominal Wounds “Selective Abstentionism versus Systematic Laparotomy”

Abstract

The management of penetrating wounds of the abdomen is still, at present, a subject of controversy. The aim of this study was to analyse the results of the management of penetrating abdominal wounds. This retrospective study was carried out over a period of 5 years, from January 2017 to January 2021. It covered 90 cases of penetrating abdominal wounds collected at the level of the Surgical Emergency Department of the Mohammed VI University Hospital of Marrakech. It involved 88 men and 2 women, with an average age of 27 years. Two groups of patients were identified. A first group of 61 patients (group I) where the diagnosis of penetration was based on the following findings: epiplocele, evisceration, flow of abdominal fluid, and in which laparotomy was systematically performed. Group II included 29 patients, with no signs of severity, who received simple wound trimming under local anaesthesia with plane-by-plane closure and simple monitoring. Age, gender, causative agent and circumstances of injury were comparable in both groups. The overall mortality was 2.2% (2 cases) and concerned only group I patients. The overall morbidity was 13.3% and consisted of: - 6 cases of peritonitis of which 5 cases were in group II, giving a secondary intervention rate of 17.2%; the other cases of morbidity concerned only group I patients with 3 cases of parietal suppuration, 2 cases of delayed transit resumption and 2 cases of evisceration. The rate of unnecessary or blank laparotomies was 25% in Group I. Laparotomy from the outset in the case of any penetrating wound of the abdomen has the advantage of making a precise assessment of the injury, hence its medico-legal interest, especially in the case of an assault. However, "selective abstentionism" has the advantage of avoiding unnecessary laparotomies. In short, there is no dogma in this matter.