Stab wounds of the anterior abdomen. Analysis of a management plan using local wound exploration and quantitative peritoneal lavage.

A management plan for stab wounds to the anterior abdomen incorporating local wound exploration and quantitative peritoneal lavage was applied to 572 patients. One hundred eighty-five of these patients presented with shock, peritonitis, or evisceration and underwent immediate exploratory laparotomy with the finding of an intraperitoneal organ injury in 183 (99%). The remaining 387 patients with a negative physical examination underwent exploration of the stab wound to determine fascial penetration. Wound exploration was negative in 151 of these patients and they were discharged from the emergency room. Two hundred thirty-six additional patients had penetration of the fascia and underwent peritoneal lavage. Ninety-two per cent of patients with lavage counts greater than 50,000 had an intraperitoneal organ injury. No patients with lavage counts less than 1,000 red cells had an organ injury. Forty-three per cent of patients in the intermediate group (1,000-50,000 RBCs/mm3) had an organ injury and 59% included penetration of a hollow viscus. An approach incorporating local wound exploration and quantitative peritoneal lavage followed by exploratory laparotomy for red blood cell counts greater than 1,000 should result in less than 10% negative laparotomies and no missed injuries.