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Management of Stab Wounds

Surgical Judgment in the Management of Stab Wounds of the Abdomen:

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SINCE 1830, the management of stab wounds of the abdomen has alternated between operative and non-operative, but the policy of routine exploration of these wounds has dominated since World War I. In that military setting, it was first shown that mortality could be lowered from 90%o to 53% by exploration of all penetrating wounds. This approach was reinforced by the experiences in World War IL and in Korea when the mortality was, respectively, 25% and 12%.29 These military precepts were enthusiastically applied to civilian wounds. At Charity Hospital in New Orleans, a rigid policy of mandatory laparotomy for all patients with wounds which might have entered the peritoneal cavity was instituted by Miles in 1891 and continued off and on9 11, 26 until 1967. Both university services at Charity Hospital adhered faithfully to the policy, the philosophy which was epitomized by Moss, Schmidt and Creech16 in their review o...f

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The Management Of Stab Wounds To The Back.

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Abstract

The management of stab wounds to the back is controversial. There are certain clear indications for exploratory laparotomy, but most cases require a diagnostic workup and a period of observation. In this article, different diagnostic modalities are presented, including local wound exploration, diagnostic peritoneal lavage, abdominal computed tomography (CT) scan, triple-contrast abdominal CT scan, and intravenous pyelography (IVP). Recommendations for management are given, with emphasis on abdominal CT scan and observation.

Management of stab wounds of the back and flank.

Abstract

Abdominal stab wounds are managed on a selective basis with increasing frequency. Retroperitoneal injuries are more difficult to evaluate; hence wounds to the flank and back pose different considerations. A retrospective review of 108 patients with deep stab wounds of the flank and back was compared with a prospective study of 109 patients selectively managed with similar injuries.

See Also: : Management Of Stab Wounds Of The Back And Flank.

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Management Of Stab Wounds Of The Back And Flank

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Abstract

Abdominal stab wounds are managed on a selective basis with increasing frequency. Retroperitoneal injuries are more difficult to evaluate; hence wounds to the flank and back pose different considerations. A retrospective review of 108 patients with deep stab wounds of the flank and back was compared with a prospective study of 109 patients selectively managed with similar injuries. Physical examination was accurate in 86% of flank and 88% of back wounds. Local exploration was an effective procedure in differentiating superficial from deep wounds. Peritoneal lavage may be more accurate in flank wounds but is probably less reliable with retroperitoneal injuries. Adjunctive studies are helpful in selected patients. The incidence of negative celiotomies was reduced from 85.2% to 7.3% when the selective approach was adopted. There was no mortality or increased morbidity in the series. Although the risk of retroperitoneal injury is greater with flank and...

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