Successful management of abdominal stab wounds with clinical evaluation: experiences of an South-African trauma unit with 496 consecutive patients

Background. Up to 80% of all operations performed in South African trauma units are due to penetrating injuries. This study should evaluate our own clinical guidelines for the management of penetrating abdominal injuries. Methods. Absolute indication for operation in patients with penetrating abdominal injuries have been: haemodynamic instability, evisceration of bowels or organs, peritonitis, free air under the diaphragm on plain abdominal x-rays, the evidence of fresh blood on rectal examination or in the stomach. No ultrasonography or CT scanning has been performed. Results. 496 patients were included in this study. In 248 (50%) patients an operation has been performed. 50 (20%) of them were initially selected for abdominal observation. In 230 (93%) patients, peritoneal penetration was diagnosed during laparotomy. In 18 (7%) patients the laparotomy was negative and in 24 (10%) non-therapeutic. 6 (2%) patients died. Specificy 93,2% (Cl 90,2-96,2%), positive prediction 92,7% (89,5%-95,7%). Conclusion. The clinical evaluation of patients with abdominal stab wounds is a save method to detect possible fatal injuries in hospitals without unlimited access to ultrasonography and CT scanning. 80% of all patients with a selective conservative approach needed no operation.