Penetrating abdominal stab wounds: a plea for a more conservative policy

McIntyre, Robert C.; Auld, C. D.; Cuschieri, R. J.; Taggart, Ian; McKay, A. J.

doi:10.1016/0020-1383(89)90013-2

Cited by 13 publications

(17 citation statements)

References 22 publications

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“…In recent years more conservative and selective approaches have been advocated in order to reduce the 40-60% incidence of unnecessary-so called nontherapeuticlaparotomies with a policy of mandatory laparotomy [7,21,26,35]. This seems quite reasonable with regard to overall treatment costs, a considerable morbidity of nontherapeutic laparotomies, which is reported to be up to 20%, and a mortality in the range of 0-5% [10,27,32].…”

Section: Discussionmentioning

confidence: 95%

“…This seems quite reasonable with regard to overall treatment costs, a considerable morbidity of nontherapeutic laparotomies, which is reported to be up to 20%, and a mortality in the range of 0-5% [10,27,32]. A large volume of literature has surfaced which considers adjunctive measures such as sinogram [1], local wound exploration [21,24,25,31,33], peritoneal tap/lavage [11,12,16,20], and combinations thereof in order to determine peritoneal penetration.…”

Section: Discussionmentioning

confidence: 99%

“…An alternative to these extremes is laparoscopy which allows the inspection of the peritoneum for signs of perforation and furthermore, in selected cases, the treatment of intraabdominal injuries [4,10,13,14,17,21,24,26,35]. The rate of nontherapeutic laparotomies, which are associated with a considerable morbidity, may thus be reduced, as well as the length of hospital stay and treatment costs [10,17,27,32].…”

mentioning

confidence: 99%

“…Many surgeons, especially in the United States, tend to follow a more conservative approach in uncomplicated cases, arguing that 30-50% of all stab wounds do not even perforate the peritoneum and another 20-40% cases with perforated peritoneum do not involve visceral injuries which require surgical interventions-resulting in nontherapeutic laparotomy rates of up to 70% [8,10,15,21,26]. Until the end of the 1980s most European surgeons recommended an exploratory laparotomy if local exploration could not determine the depth of the wound.…”

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confidence: 99%

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Emergency laparoscopy for abdominal stab wounds

et al. 1998

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Emergency laparoscopy for abdominal stab wounds

et al. 1998

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“…Such differences might reduce the applicability of US practice management guidelines in the UK. There are few published UK studies of penetrating abdominal injuries [11][12][13][14] and it is not known to what extent SNOM is being applied in the UK. 15 Survey results from 2012 indicate far less acceptance of SNOM among British and Irish surgeons than among their North American counterparts, 15 and for most UK surgeons, penetrating abdominal injuries represent an infrequent presentation, for which they have limited training and experience.…”

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confidence: 99%

Selective non-operative management of penetrating liver injuries at a UK tertiary referral centre

MacGoey

Navarro

Beckingham

et al. 2014

annals

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INTRODUCTION Selective non-operative management (SNOM) of penetrating abdominal injuries has increasingly been applied in North America in the last decade. However, there is less acceptance of SNOM among UK surgeons and there are limited data on UK practice. We aimed to review our management of penetrating liver injuries and, specifically, the application of SNOM. METHODS A retrospective review was performed of patients presenting with penetrating liver injuries between June 2005 and November 2013. RESULTS Thirty-one patients sustained liver injuries due to penetrating trauma. The vast majority (97%) were due to stab wounds. The median injury severity score was 14 and a quarter of patients had concomitant thoracic injuries. Twelve patients (39%) underwent immediate surgery owing to haemodynamic instability, evisceration, retained weapon or diffuse peritonism. Nineteen patients were stable to undergo computed tomography (CT), ten of whom were selected subsequently for SNOM. SNOM was successful in eight cases. Both patients who failed SNOM had arterial phase contrast extravasation evident on their initial CT. Angioembolisation was not employed in either case. All major complications and the only death occurred in the operatively managed group. No significant complications of SNOM were identified and there were no transfusions in the nonoperated group. Those undergoing operative management had longer lengths of stay than those undergoing SNOM (median stay 6.5 vs 3.0 days, p<0.05). CONCLUSIONS SNOM is a safe strategy for patients with penetrating liver injuries in a UK setting. Patient selection is critical and CT is a vital triage tool. Arterial phase contrast extravasation may predict failure of SNOM and adjunctive angioembolisation should be considered for this group.

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