The Role of Selective Management of Penetrating Abdominal Wounds
With the rising incidence of urban violence and related events, we observed a proportional rise in the number of patients with penetrating abdominal wounds. It is necessary, in these patients, to validate clinical and radiological criteria to justify the use of diagnostic laparotomy, since this procedure is associated with significant pre- and postoperation morbidity.
In a retrospective study of the patients submitted to diagnostic laparotomy at Municipal Hospital Miguel Couto (Rio de Janeiro, Brazil) between April 1995 and April 2000, it was observed that, of 562 laparotomies in patients with penetrating abdominal trauma, 82 (14.6%) were considered negative, without intra-abdominal lesions. Of these, 31 were gunshot wounds (9.6% of the gunshot-related laparotomies) and 51 were stab wounds (21.2 per cent of the stab wound related laparotomies).
We conclude that the high rate of unnecessary abdominal exploration in patients with stab wounds make this group suitable for selective management based on clinical grounds. Conversely, gunshot wounds patients, once confirmed abdominal penetration, are candidates for surgical intervention.
Key words: abdomen; gunshot; management; penetrating; stab wounds
E-mail: lucanunes@dr.com
Prehosp Disast Med 2001;16(2):s59.
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