Can unnecessary operations for abdominal stab would be safely reduced? A review of 255 patients.

Records of 255 patients who underwent laparotomies for stab wounds to the abdomen and lower chest were reviewed. Criteria for laparotomy were clinical and followed the conventional lines. Seventy-six patients (30%) were classified as having had an unnecessary laparotomy. Univariate analysis with the Chi-square test revealed 8 variables which differed significantly between the necessary and unnecessary laparotomy groups. Further stepwise discriminant analysis demonstrated 4 variables which had independent significance; they are the type of injury, generalized abdominal tenderness, haemoperitoneum and active intraabdominal bleeding. A mathematical model utilizing these 4 variables may be able to predict the need for laparotomy more accurately than utilizing any single variable. A prospective study is needed to test this hypothesis.

Intestinal obstruction due to phytobezoars.

Seven adults and four children with phytobezoar obstruction to the small bowel were reported. All adult patients had undergone previous laparotomies, six of which were gastric operations. Phytobezoar obstruction was not suspected in any of the adult patients and surgery was necessary to relieve the obstruction. Abnormal gastric function may predispose phytobezoars, and surgeons should be aware of the possibility in patients with previous gastric surgery. The children had been previously healthy, but all had a history of eating an excessive amount of fruit or seeds before the onset of symptoms. The obstruction was found to be incomplete and could be relieved by conservative treatment, including the use of colonic washouts. In children with intestinal obstruction a good dietary history should lead to the correct diagnosis so that surgery may be avoided.