DOI: http://dx.doi.org/10.18203/2349-2902.isj20193308

Conservative management of penetrating abdominal trauma (stab wound)

Magdy Ahmed Loulah, Asem Fayed Mostafa, Osama Soliman El-Balky, Abdel-Rahman Mohamed Mohamed Mohamed El-Meligi

Abstract


Background: The aim of the study is to study the reliability of selective conservative management of the penetrating stab abdominal wounds. Trauma is one of the most important reasons of mortality. The mechanism that underlies the penetrating trauma relates to the mode of injury. The early diagnosis of hollow viscus injuries is difficult and a delay in the diagnosis of such injuries may be associated with increased morbidity and mortality. Focused assessment with sonography for trauma (FAST) is an effective for screening and initial classification of stable patients and confirmed by CT scan. The management of stable patients was either surgical exploration or selective non-operative interference with the optimal management of patients is yet to be fully elucidated for abdominal stab wounds (ASW).

Methods: A prospective study of 40 patients with penetrating abdominal stab wounds between June 2017 and February 2018, at Damanhour Medical National Institute.

Results: The mean age of our patients was 51.9±13.3 years with predominance of males and without predominance of any side to be affected and non-significant deviation from the normal values of hemodynamic signs. The presence of air under diaphragm in X-ray films signify abdominal penetration and ultrasonographic examination (FAST) document the diagnosis and help in following up of cases. Most of hemodynamically stable patients passed conservatively with a little rate of laparotomy.

Conclusions: We concluded that there is still a role for conservative management in managing stable cases of penetrating stab abdominal wound. 


Keywords


FAST, ASW, Computed tomography

Full Text:

PDF

References


Forouzanfar MM, Safari S, Niazazari M, Baratloo A, Hashemi B, Hatamabadi HR, et al. Clinical decision rule to prevent unnecessary chest X‐ray in patients with blunt multiple traumas. Emerg Med Australas. 2014;26(6):561-6.

Jansen JO, Inaba K, Rizoli SB, Boffard KD, Demetriades D. Selective non-operative management of penetrating abdominal injury in Great Britain and Ireland: survey of practice. Injury. 2012;43(11):1799-804.

Mahmood I, Tawfek Z, Abdelrahman Y, Siddiuqqi T, Abdelrahman H, El-Menyar A, et al. Significance of Computed Tomography Finding of IntraAbdominal Free Fluid Without Solid Organ Injury after Blunt Abdominal Trauma:Time for Laparotomy on Demand. World J Surg 2014;38:1411-5.

Kelley SR, Tsuei BJ, Bernard AC, Boulanger BR, Kearney PA, Chang PK. The effectiveness of focused assessment with sonography for trauma in evaluating blunt abdominal trauma with a seatbelt mark sign. J Curr Surg. 2014;4(1):17-22.

Behboodi F, Amiri ZM, Masjedi N, Shojaie R, Sadri P. Outcome of Blunt Abdominal Traumas with Stable Hemodynamic and Positive FAST Findings. Emergency. 2016;4(3):136-9.

Kevric J, O’Reilly GM, Gocentas RA, Hasip O, Pilgrim C, Mitra B. Management of hemodynamically stable patients with penetrating abdominal stab injuries: review of practice at an Australian major trauma centre. Eur J Trauma Emerg Surg. 2016;42:671-5.

Biffl WL, Leppäniemi A. Management guidelines for penetrating abdominal trauma. World J Surg. 2015;39(6):1373-80.

Plackett TP, Fleurat J, Putty B, Demetriades D, Plurad D. Selective nonoperative management of anterior abdominal stab wounds:1992-2008. J Trauma. 2011;70:408-13.

Ojo EO, Ozoilo KN, Sule AZ, Ugwu BT, Misauno MA, Ismaila BO, et al. Abdominal injuries in communal crises:The Jos experience. J Emerg Trauma Shock. 2016;9:3-9.

Osinowo AO, Olusoji OO, Adesanya AA. Abdominal stab wounds in Lagos: A review of fifty cases. Niger Postgrad Med J. 2016;23:86-92.

Kumar RKA, Chandrakumar SVPL, Vijayalaxmi A, Naik AB, Bharat KYN, Abbas J. Penetrating injury abdomen:a study at government general hospital. J Evidence Based Med Healthcare. 2015;2(17):2378-83.

Ramya C, Jayasree K. A profile of 96 cases of penetrating injury of abdomen. Int J Res Med Sci. 2017;5(7):2993-7.

Dayananda KSS, Kong VY, Bruce JL, Oosthuizen GV, Laing GL, Clarke DL. Selective non-operative management of abdominal stab wounds is a safe and cost effective strategy: A South African experience. Ann R Coll Surg Engl. 2017;99:490-6.

Bennett S, Amath A, Knight H, Lampron J. Conservative versus operative management in stable patients with penetrating abdominal trauma:the experience of a Canadian level 1 trauma centre. Can J Surg. 2016;59(5):317-21.

Al-Ozaibi L, Al-Suwaidi N, Al-Zarouni N, Abou Hussein BM, Khalil OM, Al-Mazrouni A, et al. Penetrating abdominal stab wounds:current practice and recommendations. Hamdan Med J 2017;10(2):113-9.

Shashikala CK, Gautham MV, Kagwad S. Changing trends in the management of penetrating abdominal trauma:from mandatory laparotomy towards conservative management. Ann Int Med Den Res. 2016;2(6):SG19-SG23.

Üstüner MA, İlhan E, Yıldırım M, Aykas A, Şenlİkcİ A, Değerlİ V, et al. Penetrating stab wounds to the abdominal wall: Retrospective analysis of 131 cases: Can the number of unnecessary laparotomies be reduced? Tepecik Eğit. ve Araşt. Hast Dergisi. 2015;25(3):143-50.

Herfatkar MR, Mobayen MR, Karimian M, Rahmanzade F, Baghernejad Monavar Gilani S, Baghi I. Serial clinical examinations of 100 patients treated for anterior abdominal wall stab wounds:a cross sectional study. Trauma Mon. 2015;20:e24844.

Paydar S, Salahi R, Izadifard F, Jaafari Z, Abbasi HR, Eshraghian A, et al. Comparison of conservative management and laparotomy in the management of stable patients with abdominal stab wound. Am J Emerg Med. 2012;30:1146-51.