Walter L Biffl1, Ari Leppaniemi. 1. Department of Surgery, Denver Health Medical Center/University of Colorado, 777 Bannock Street, MC 0206, Denver, 80204-4507, CO, USA, walt@biffl.com.
Abstract
INTRODUCTION: The optimal management of patients with penetrating abdominal injuries has been debated for decades, since mandatory laparotomy (LAP) gave way to the concept of "selective conservatism." MATERIALS AND METHODS: A comprehensive literature review was performed and summarized. RESULTS: A proposed management guideline for patients with penetrating abdominal trauma was created. CONCLUSION: Indications for immediate laparotomy (LAP) include hemodynamic instability, evisceration, peritonitis, or impalement. Selective nonoperative management of stable, asymptomatic patients has been demonstrated to be safe. Adjunctive diagnostic testing-ultrasonography, computed tomography, local wound exploration, diagnostic peritoneal lavage, laparoscopy-is often used in an attempt to identify significant injuries requiring operative management. However, prospective studies indicate that these tests frequently lead to nontherapeutic LAP, and are not cost-effective.
INTRODUCTION: The optimal management of patients with penetrating abdominal injuries has been debated for decades, since mandatory laparotomy (LAP) gave way to the concept of "selective conservatism." MATERIALS AND METHODS: A comprehensive literature review was performed and summarized. RESULTS: A proposed management guideline for patients with penetrating abdominal trauma was created. CONCLUSION: Indications for immediate laparotomy (LAP) include hemodynamic instability, evisceration, peritonitis, or impalement. Selective nonoperative management of stable, asymptomatic patients has been demonstrated to be safe. Adjunctive diagnostic testing-ultrasonography, computed tomography, local wound exploration, diagnostic peritoneal lavage, laparoscopy-is often used in an attempt to identify significant injuries requiring operative management. However, prospective studies indicate that these tests frequently lead to nontherapeutic LAP, and are not cost-effective.
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