Selective non-operative management of stab wounds to the posterior abdomen is safe: the Pietermaritzburg experience. Issue 9 (September 2015)

• Record Type: Journal Article
• Authors: Kong, Victor; Oosthuizen, George; Sartorius, Benn; Clarke, Damian
• Is Part Of: Injury. Volume 46:Issue 9(2015)
• Page Start: 1753
• Page End: 1758
• Publication Date: 2015-09
• Subjects: Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2015.01.004
• Languages: English
• ISSNs: 0020-1383

Abstract

<abstract abstract-type="author" id="abs0005"> <title id="sect0005">Abstract</title> <sec> <title id="sect0010">Introduction</title> <p id="spar0005">The selective non-operative management (SNOM) of stab injuries of the anterior abdomen is well established, but its application to the posterior abdomen remains controversial.</p> </sec> <sec> <title id="sect0015">Materials and methods</title> <p id="spar0010">A retrospective review of 1013 patients was undertaken at a major trauma service in South Africa over a five-year period.</p> </sec> <sec> <title id="sect0020">Results</title> <p id="spar0015">Ninety per cent of patients were males, and the mean age was 25 years. The mean time from injury to presentation was 4 h and 73% of all injuries were inflicted by knives. A total of 9% (93) of patients required a laparotomy [Group A] and 82% (833) were successfully observed without the need for operative intervention [Group B]. CT imaging was performed on 52 patients (5%) who had haematuria [Group C], 25 (3%) who had neurological deficits [Group D], and 10 (1%) with retained weapon injuries [Group E]. The accuracy of physical examination for identifying the presence of organ injury was 88%. All observed patients who required laparotomy declared themselves within 24 h. There were no mortalities as direct result of our current management protocol.</p> </sec> <sec> <title id="sect0025">Conclusions</title> <p id="spar0020">Selective management based on active clinical observation and serial physical examination is safe, and when coupled with the judicious use of advanced imaging, is a prudent and reliable approach in a resource constrained environment.</p> </sec> </abstract>