Indications for thoracotomy in stab injuries of the chest: A prospective study of 543 patients

Abstract

This is a prospective study of 543 patients with stab wounds of the chest treated in a 15 month period. Four hundred and sixty-seven patients (86 per cent) were selected for conservative treatment with no mortality. Of the 76 patients in the operatively treated group 68 were operated on in the operating theatre with a mortality of 17 per cent, while the remaining eight had a thoracotomy in the resuscitation room with a mortality of 87.5 per cent. Indications for early operation would appear to be the presence of signs of cardiac or major vascular injury (i.e. tamponade, profuse bleeding, an absent or diminished peripheral pulse, and shock not responding to aggressive resuscitation). A cautious digital exploration of the chest wound may help identify these injuries by obtaining information about the knife tract (towards or away from the heart or major vessels). The presence of shock on admission should not be an absolute indication for operation. Half the 156 patients with shock on admission were treated conservatively with no mortality. The presence of a wound over the precordium is not in itself an absolute indication for surgery. Seventy-two such patients, including 14 with shock, were successfully treated non-operatively. Massive air leaks are usually self-controlled and none of the 24 such cases required operation. The amount or rate of blood loss via the thoracotomy tube is not a reliable index of the severity of the injury and it should not be a sole criterion for the selection of the type of treatment.

Penetratıng Stab Wounds To The Abdominal Wall: Retrospective Analysıs Of 131 Cases: Could Unnecessary Laparotomies Be Reduced?

“…Moreover, even the determination of organ evisceration is an absolute indication for laparotomy is controversial (28)(29)(30) . While in some publications, evisceration alone without signs of shock and peritoneal irritation are not accepted as indication for emergent laparotomy (28,31,32) ; in some publications, emergent laparotomy is recommended as the rate of organ injury is very high (10,29,30,33) . The presence of signs of peritoneal irritation and shock detected during physical examination suggests the presence of a severe pathology.…”

Spontaneous regeneration capacity of controlled small bowel perforations: an experimental study in rats

“…Routine laparotomy is not indicated in hemodynamically stable patients with penetrating abdominal stab wounds without signs of peritonitis or diffuse abdominal tenderness. [8,[12][13][14] Two approach models including emergency laparotomy and selective observation model have been described for penetrating abdominal trauma. [15][16][17][18] The only treatment choice for patients with penetrating abdominal trauma was routine laparotomy before the 1960s.…”

“…This method has diminished both negative laparotomy rates and morbidity caused by negative laparotomy. [2][3][4][5][6][7] Besides the advantages of selective observation, it has also arisen some questions. One of these questions is the presence of a healing chance of a perforated small bowel without surgical intervention.…”

“…Retrospective analysis of patients with penetrated abdominal trauma has shown that small bowel wound ratio is found to be higher in clinics using routine laparotomy compared to those using selective observation method. [2][3][4][5] Therefore, there can be a possibility of spontane-…”

General approach to penetrating abdomen traumas of Turkish General Surgeons: Survey of practice

“…[2][3][4] Bu amaçlar doğrultusunda birçok travma merkezinde acil laparotomi endikasyonu olmayan delici-kesici alete bağlı karın yaralanmalarında (DKAY) 'selektif non-operatif yöne-tim' (SNOY) genel kabul gören yaklaşım haline gelmiştir. [5][6][7][8][9][10] Son yirmi yılda özellikle gelişmiş görüntüleme teknikleri sayesinde SNOY yaklaşımının ateşli silaha bağlı karın yaralanmalarında da (ASY) etkili ve güvenilir olduğu gösterilmiştir. [11][12][13][14][15][16] The Eastern Association for the Surgery of Trauma Practice Management Guidelines Committee yayınladığı kılavuzda PKT'de hangi hastaların güvenle non-operatif olarak takip edilebileceğini belirtmiştir.…”