The role of peritoneal lavage in the management of stab wounds to the abdomen

Abstract

In a 2 year period, 237 patients presented with stab wounds to the lower chest and anterior abdomen. Ninety-six patients were discharged from the emergency room after negative findings on wound exploration. There were no apparent missed injuries but two wound infections in this group for an overall morbidity of 2.1 percent. One hundred forty-one patients underwent exploratory laparotomy. Seventy-seven required emergency laparotomy because of hemodynamic signs of blood loss or peritonitis. Sixty-four patients whose only indication for laparotomy was penetration of the anterior abdominal wall fascia by local wound exploration underwent peritoneal lavage before laparotomy. If 50,000 red blood cells/mm 3 in the lavage fluid had been used to select patients for observation, the incidence of negative laparotomy would have been reduced from 58 to 3.2 percent, and only one significant visceral injury would have been missed. Peritoneal lavage in properly selected patients, used in combination with local wound exploration and careful clinical observation, can be a useful diagnostic modality both in predicting significant visceral injury and in lowering the incidence of negative findings at laparotomy in patients with stab wounds to the abdomen.