Penetrating Abdominal Trauma - Observe vs Laparotomy

Author: Michelle Lin, MD
Updated: 7/9/2010

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.

Wound Management

  • 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
Patient Management

unstable or diffuse
abdominal tenderness

Immediate laparotomy

Unreliable clinical exam
(eg. head or c-spine injury,
intoxication, intubated)

Laparotomy or imaging

Hemodynamically stable
and reliable clinical exam

  • “Strongly consider” triple-contrast (PO, IV, PR) abdominopelvis CT
  • Serial abdominal examinations over 24 hours
  • Consider local wound exploration to determineanterior fascial integrity

Complications From Laparotomy

Overall incidence of complications: 2.5-41%

  • Acute myocardial infarction
  • Aspiration pneumonia
  • Bowel obstruction
  • Deep venous thrombosis
  • Ileus
  • Pancreatitis
  • Pneumothorax
  • Urinary tract infection
  • Visceral injury
  • Wound infection
  • Longer hospital stay
  • Death

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]