Non-operative management of stable patients with abdominal stab wounds: is it feasible in Egyptian patients?

ABSTRACT

Non-therapeutic laparotomy morbidity rate in patients with stab wounds is approximately 40% . Selective conservative management, rather than mandatory laparotomy, is a better approach. We studied patients with penetrating abdominal stab wounds admitted to Alexandria Main University Hospital [Referral hospital] during 5 years from January 2001 to December 2005. This study included total 308 stabs in 275 patients, mean age 33 years [range 12-75 years]; 246 [89%] male. Mean admission systolic blood pressure of negative laparotomy in was 115 mm Hg [range 60-155 mm Hg]; while for positive laparotomy it was 90 mm Hg [range 45-140 mm Hg]. 236 [85%] only had US, and 182[65%] had CT. 112 [47%] of them bad positive clinical and/or imaging results, all underwent laparotomy 99 [88%] therapeutic, 13 [12%] negative. In patients with negative clinical as well as US and CT, only 63[35%] had successful non-operative management and 107 [65%] had laparotomy, which was unnecessary negative in 98 [95%]. CT accurately predicted laparotomy need in 1 65/1 82 [91%] patients. In patients with penetrating stab abdominal wound, hypotension was the main clinical indicator for urgent operation. In hemodynamically stable patients, abdomino-pelvic CT with contrast bad high sensitivity to predict need for laparotomy