The nonoperative management of penetrating abdominal trauma

Abstract

The management of penetrating injuries to the abdomen has evolved back to a selective nonoperative approach. Using clinical examination for screening, evaluable patients without hemodynamic instability or peritonitis can safely undergo a trial of nonoperative management. For stab wounds, this involves serial clinical examination with delayed laparoscopic evaluation of the diaphragm for left thoracoabdominal injuries and CT scanning for suspected solid-organ injuries. The same contraindications to nonoperative management apply to gunshot injuries. Gunshot injuries undergoing nonoperative management require detailed trajectory imaging with CT. The presence of peritoneal violation without definite organ injury requires serial clinical examination. Isolated solid-organ injury is not an absolute contraindication to nonoperative management and may benefit from advanced endovascular and percutaneous interventions to facilitate management. Selective nonoperative management of both stab wounds and gunshot injuries is safe and has been shown to decrease the rate of unnecessary laparotomy, length of hospital stay, and management costs.