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Importance of the Physical Examination

Robert M. Shorr, MD; Michael M. Gottlieb; Kenneth Webb, RN; Leonard Ishiguro; Thomas V. Berne, MD

Arch Surg. 1988;123(9):1141-1145.

Abstract
• The treatment of patients with anterior abdominal stab wounds remains controversial. We reserve celiotomy for patients who have clinical findings of peritonitis or hemorrhage. Repeated physical examination is the most important element of observation. Recently, 330 patients with stable abdominal stab wounds presented over a 12-month period. These patients were followed up with serial physical examinations and laboratory measurements. Of the 330 patients, 107 patients (32%) required celiotomy for the repair of a life-threatening injury (group 1); 28 patients (8%) underwent nontherapeutic cellotomies (group 2); 19 patients (6%) had negative explorations (group 3); and 176 patients (53%) were observed and discharged (group 4). There were three missed injuries in group 4. Serial physical examination can be a reliable technique in the management of abdominal stab wounds and is comparable to other approaches.

(Arch Surg 1988;123:1141-1145)

Author Affiliations
From the Department of Surgery, University of Southern California School of Medicine and the Los Angeles County—University of Southern California Medical Center.

Footnotes
Accepted for publication May 3, 1988.

Read before the 59th Annual Meeting of the Pacific Coast Surgical Association, San Francisco, Feb 23, 1988.

Reprint requests to Department of Surgery, LAC-USC Medical Center, 1200 N State St, Los Angeles, CA 90033 (Dr Shorr).

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