Prediction of injury caused by penetrating wounds to the abdomen, flank, and back
M. C. McCarthy, G. A. Lowdermilk, D. F. Canal and T. A. Broadie
Indiana University Regional Trauma Center, Indianapolis.
Controversy about the appropriate evaluation of penetrating abdominal,
flank, and back injuries prompted this retrospective review of 311 patients
at an urban level 1 trauma center over 5 years. Seventy-five (24%) patients
sustained gunshot wounds to the abdomen. All patients with gunshot wounds
underwent exploratory laparotomy; results of 67 laparotomies (89%) were
positive. Of 236 patients sustaining stab wounds (140 abdominal wounds, 51
flank wounds, 26 back wounds, and 19 wounds to multiple sites), 147 were
treated according to a selective protocol, based on results of physical
examination, wound exploration, peritoneal lavage, and ancillary diagnostic
studies. No injuries were found at celiotomy in three (2%) of these 147
patients. One false-negative result of evaluation of a flank wound
occurred. Significant injuries were found in 13 patients (68%) with stab
wounds to multiple sites, 61 patients (44%) with abdominal stab wounds, 15
patients (29%) with flank stab wounds, and four patients (15%) with back
stab wounds. Mandatory exploration of gunshot wounds is justified. Physical
findings of intra-abdominal injury or positive results of peritoneal lavage
identify stab wound victims likely to benefit from surgical exploration. A
policy of mandatory observation or routine celiotomy for treatment of stab
wounds is not justified.
