Penetrating Abdominal Trauma - Observe vs Laparotomy
Penetrating Abdominal Trauma: Observe versus Laparotomy
Eastern Association for the Surgery Trauma (EAST) guidelines
- Diagnostic peritoneal lavage is no longer indicated, because eplaced by the use of serial abdominal exams and triple-contrast CT abd-pelvis.
- Patients with a stab wound to flank/back should also receive a triple-contrast CT abd-pelvis.
- A negative bedside FAST ultrasound does not replace need for triple-contrast CT in a stable patient.
- Gun shot wounds (GSW) – All require laparatomy exploration because of higher incidence of intra-abdominal injuries.
- Stab wounds (SW) to anterior abdomen - Can be observed vs laparotomy
Unreliable clinical exam
Laparotomy or imaging
Complications From Laparotomy
Overall incidence of complications: 2.5-41%
- Acute myocardial infarction
- Aspiration pneumonia
- Bowel obstruction
- Deep venous thrombosis
- Urinary tract infection
- Visceral injury
- Wound infection
- Longer hospital stay
Goal: Minimize number of unnecessary laparotomies
- Como JJ et. al. Practice management guidelines for selective nonoperative management of penetrating abdominal trauma. J Trauma. 2010 Mar;68(3):721-33. [PubMed]