Criteria for Early Laparotomy in abdominal stab wound

ABSTRACT

Patients with an abdominal stab wound presenting with shock, peritonitis or eviscerarion are usually subjected to early laparotomy, although very few studies have been done to validate the criteria. To validate that early laparotomy for stab wounds is compulsory or other diagnostic methods may be helpful to prevent unnecessary laparotomy in certain cases. The study was carried out in surgical unit-1, Nishtar Hospital, Multan during the period from January 2003 to June 2008. A total of 110 patients with stab wounds of the anterior abdomen, flank or lower chest were evaluated for their accuracy in predicting the presence of significant abdominal organ injury. Overall, 47 patients had a significant abdominal injury [42.7%]. The signs of peritoneal penetration including omental evisceration, air under the diaphragm or free fluid in the abdomen were not the independent predictors of significant injury. Signs of major internal haemorrhage or generalized peritonitis are reliable criteria by themselves for early laparotomy. Peritoneal penetration is a poor indicator of significant organ injury and warrants direct organ specific evaluation, such as computed tomography or laproscopy, to identify, patients who can safely be treated without operation