Is exploratory celiotomy necessary for all patients with truncal stab wounds?

Abstract

Mandatory exploratory celiotomy was carried out in 1241 consecutive patients with truncal stab wounds. Four hundred seventy-one (38%) patients who had no intra-abdominal injury identified at operation developed 16 complications (3%), with one patient (0.2%) dying postoperatively. The average length of hospitalization (5 days) was increased if the patient: (1) required a simultaneous operation for associated site injuries (9 days), (2) developed postoperative complications (16 days), or (3) required reoperation (27 days). The 1990 projected cost per patient for routine celiotomy has increased 92% over that seen 10 years ago. Selective management protocols using observation, repeated physical examination, and special diagnostic procedures could be instituted for asymptomatic hemodynamically stable patients with truncal stab wounds if appropriate facilities and personnel are available. Successful implementation should preserve medical resources for those patients with trauma requiring a life-saving operation.