[Successful management of abdominal stab wounds with clinical evaluation: experiences of an South-African trauma unit with 496 consecutive patients].
BACKGROUND: Up to 80% of all operations performed in South African trauma units are due to penetrating injuries. This study will evaluate our own clinical guidelines for the management of penetrating abdominal injuries. METHODS: Absolute indication for operation in patients with penetrating abdominal injuries have been: haemodynamic instability, evisceration of bowels or organs, peritonitis, free air under the diaphragm on plain abdominal x-rays, the evidence of fresh blood on rectal examination or in the stomach. No ultrasonography or CT scanning has been performed. RESULTS: 496 patients were included in this study. In 248 (50%) patients an operation has been performed. 50 (20%) of them were initially selected for abdominal observation. In 230 (93%) patients, peritoneal penetration was diagnosed during laparotomy. In 18 (7%) patients the laparotomy was negative and in 24 (10%) non-therapeutic.6 (2%) patients died. Specifically 93.2% (CI 90.2-96.2%), positive prediction 92.7% (89.5%-95.7%). CONCLUSION: The clinical evaluation of patients with abdominal stab wounds is a safe method to detect possible fatal injuries in hospitals without unlimited access to ultrasonography and CT scanning. 80% of all patients with a selective conservative approach needed no operation.