Journal Article

Management Guidelines for Penetrating Abdominal Trauma

Leppaniemi, Ari, Biffl, Walter L.

2015

Overview

Introduction The optimal management of patients with penetrating abdominal injuries has been debated for decades, since mandatory laparotomy (LAP) gave way to the concept of “selective conservatism.” Materials and Methods A comprehensive literature review was performed and summarized. Results A proposed management guideline for patients with penetrating abdominal trauma was created. Conclusion Indications for immediate laparotomy (LAP) include hemodynamic instability, evisceration, peritonitis, or impalement. Selective nonoperative management of stable, asymptomatic patients has been demonstrated to be safe. Adjunctive diagnostic testing—ultrasonography, computed tomography, local wound exploration, diagnostic peritoneal lavage, laparoscopy—is often used in an attempt to identify significant injuries requiring operative management. However, prospective studies indicate that these tests frequently lead to nontherapeutic LAP, and are not cost-effective.

• Publisher: Springer International Publishing,John Wiley & Sons, Inc
• Subject: Abdominal Injuries - etiology / Abdominal Injuries - therapy / Abdominal Surgery / Abdominal Trauma / Algorithms / Cardiac Surgery / Clinical Decision-Making / Diagnostic Imaging / Diagnostic Peritoneal Lavage / Diaphragmatic Injury / General Surgery / Hemodynamic Compromise / Humans / Laparoscopy / Laparotomy / Medicine / Medicine & Public Health / Peritoneal Lavage / Peritonitis - etiology / Peritonitis - therapy / Significant Injury / Surgery / Surgical Symposium Contribution / Thoracic Surgery / Vascular Surgery / Wounds, Penetrating - complications / Wounds, Penetrating - therapy