Management guidelines for penetrating abdominal trauma.

Abstract

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." A comprehensive literature review was performed and summarized. A proposed management guideline for patients with penetrating abdominal trauma was created. 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.