Is exploratory celiotomy necessary for all patients with truncal stab wounds?
K. R. Sirinek, C. P. Page, H. D. Root and B. A. Levine
Department of Surgery, University of Texas Health Science Center, San Antonio 78284-7842.
Mandatory exploratory celiotomy was carried out in 1241 consecutive
patients with truncal stab wounds. Four hundred seventy-one (38%) patients
who had no intra-abdominal injury identified at operation developed 16
complications (3%), with one patient (0.2%) dying postoperatively. The
average length of hospitalization (5 days) was increased if the patient:
(1) required a simultaneous operation for associated site injuries (9
days), (2) developed postoperative complications (16 days), or (3) required
reoperation (27 days). The 1990 projected cost per patient for routine
celiotomy has increased 92% over that seen 10 years ago. Selective
management protocols using observation, repeated physical examination, and
special diagnostic procedures could be instituted for asymptomatic
hemodynamically stable patients with truncal stab wounds if appropriate
facilities and personnel are available. Successful implementation should
preserve medical resources for those patients with trauma requiring a
life-saving operation.
