The traditional approach to the management of patients with stab wounds to the anterior abdomen has been exploratory laparotomy. But, controversy still exists regarding the management of patients with stab wounds to the anterior abdomen who are
hemodynamically stable and have no signs of peritonitis.
The article reviews our experience with 33 cases of stab wounds of the abdomen from january 1, 1985 to December 31, 1989 with selective management. Thirty-three patients managed according to the protocol of physical examination, local wound
exploration,
and peritoneal lavage were divided into three groups for purposes of analysis;
Group I consists of 18 patients who presented with 'positive' physical examination. (positive sign; shock, peritonitis or evisceration).
Group II consists of 6 patients with a "negative" physical examination whose stab wounds were explored under local anesthesia and were not found to penetrate the fascia. Group III consists of 9 patients who had a negative physical examination but
a
positive local wound exploration.
@ES The following results were obtained;
@EN 1) The incidence of age is between 20 and 39 years in 22 cases(66.7%) and the male to female ratio was 7.3 : 1.
2) The frequency of injury was increased annally but seasonal variation was not significant.
3) Most injury occured at night between 8 P. M. and 4, A. M.
4) In 26 cases(78.8%) of the stab wounds were homicide and 7 cases(21.2%) were sucide.
5) In 25 cases(75.8%), the instruments was a knife, and in 5 cases(15.2%), it was a broken glass.
6) The most common occupation of injured patients was no job and next, service part and in 14 cases(42.4%) were alochol drunken state.
7) The external site of stab wounds was most commonly left upper quadrant of abdomen in 10 cases(27.8%) and the distribution of left side abdomen were 17 cases(47.2%).
8) The operation was performed in 18 cases of Group I and 6 cases of Group III. The exploration rate was 72.7%(24/33). The negative unnecessary laparotomy occured in 2 cases of Group I; omental evisceration in 1 cases, small bowel evisceration
in
1
cases. The negative explation was 16.7%(1/6), 1 cases of Group III and delayed operation and showed only hemoperitoneum sign.
9) The organ which most commonly injured was small bowel(7 cases; 29.1%) and stomach(6 cases; 25.0%).
10) The average hospital stay was 11.2 days, 14.2 days for Group I, 3.9 days of Group II and 10.0 days for Group III.
|