Selective non-operative management of anterior abdominal stab wounds with emphasis on the value of follow-up abdominal CT scanning

Abstract

Background and aim

Selective non-operative management of patients with penetrating abdominal stabs is the preferred treatment strategy. The present study aimed to assess the efficacy and safety of non-operative management with emphasis on the value of follow-up abdominal CT scanning in management of patients with penetrating anterior abdominal stab.

Patients and methods

This is a retrospective chart review of stable patients with anterior abdominal stab wounds. Patients were divided in terms of initial decisions into two groups: laparotomy group and non-operative management group. Abdominal CT scan was performed for patients in the non-operative management group on admission and follow-up CT scanning was performed in cases of clinical and/or biochemical deterioration.

Results

The laparotomy group included 82 patients and 68.2% of them had unnecessary laparotomies. The non-operative management group comprised 97 patients and 90.7% of them did not require subsequent laparotomy. Abdominal CT scan had a sensitivity of 88.9% and specificity of 100% in detection of intra-abdominal injuries. Follow-up CT scanning detected bowel injuries missed by initial CT scan in three patients. The non-operative management group had significantly lower post-operative complication rate than the laparotomy group (4.1% vs. 18.3%), with a significantly shorter length of stay.

Conclusions

Non-operative management is the optimal management strategy for stable patients with penetrating anterior abdominal stab to decrease unnecessary laparotomy rates, hospital stay and costs. Follow-up abdominal CT scanning facilitated the decision making for patients selected for non-operative management and is highly sensitive in the diagnosis of patients who require subsequent exploration.

Keywords

Non-operative management penetrating stab abdominal CT

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