Relationship between the anatomical location and the selective non-operative management of penetrating stab wounds in the abdomen

• Published in: Cirugia española (English ed.)
• Main Authors: Tudela Lerma, María, Turégano Fuentes, Fernando, Pérez Díaz, María Dolores, Rey Valcárcel, Cristina, Martín Román, Lorena, Ruiz Moreno, Cristina, Fernández Vázquez, María Luz, Fernández Martínez, María
• Format: Journal Article
• Language: English; Spanish
• Published: Spain 13-02-2021
• Subjects: Abdominal trauma; Herida por arma blanca; Manejo selectivo no operatorio; Trauma abdominal; Selective non-operative management; Stab wound; Penetrante; Cirugía de urgencia; Emergency surgery; Penetrating
• ISSN: 2173-5077
• DOI: 10.1016/j.ciresp.2020.12.003

The relationship between the anatomical location of penetrating abdominal stab wounds (SW) and the rate of selective non-operative management (SNOM) based on that location is scarcely reflected in the specialized literature. Our main objective has been to assess this rate based on the anatomical location, and our results.
Retrospective review of a prospective registry of abdominal trauma from April 1993 to June 2020. The two study groups considered were the Operative Management (OM), and the SNOM, including in this one the use of diagnostic laparoscopy. Penetrating SWs in the abdomen were classified according to anatomical location.
We identified 259 patients who fulfilled the inclusion criteria. SNOM was applied in 31% of the patients with a success rate of 96%, and it was more frequent in the lumbar, flank, and thoraco-abdominal regions; within the anterior abdomen it was more applicable in the RUQ, followed by the LUQ and epigastrium, respectively. An unnecessary laparotomy was done in 21% of patients, with the highest number in the epigastrium. Taking into account the unnecessary laparotomies and the rates of successful SNOM, 70,5% of lumbar, el 66,5% of epigastric, 62% of flank, and 59% of RUQ penetrating SWs could have been managed without a laparotomy.
SNOM of penetrating SWs in the abdomen has been safer and more applicable in those located in the lumbar, flank, epigastric, and RUQ regions.