Role of laparoscopy in the evaluation of abdominal stab wounds

ABSTRACT

Laparoscopy was performed on 30 patients with stab wounds to the abdomen to identify those with peritoneal penetration. Diagnostic or therapeutic manoeuvres were not attempted, evidence of peritoneal penetration mandated exploratory laparotomy. All patients were haemodynamically stable, with no evidence of intraperitoneal injury by clinical assessment. Eighteen patients [60%] underwent negative laparoscopy and no intraperitoneal injury was subsequently detected. Most of the patients [89%] with negative laparoscopy had anterior stab wounds to the abdomen. Laparoscopy demonstrated peritoneal penetration in twelve patients [40%] and subsequent laparotomy detected intraperitoneal injuries in ten patients [83%]. A nontherapeutic laparotomy rate of 8% was recorded. A complication rate of 6% due to laparoscopy was detected, all cases were managed conservatively with no deaths. In haemodynamically stable patients with anterior stab wounds to the abdomen and no clinical evidence of intraperitoneal injury, laparoscopy effectively and safely detects those with peritoneal penetration