Negative findings on laparotomy for trauma

Abstract

A retrospective review of 428 exploratory laparotomies for trauma included 199 patients with blunt trauma, 96 with gunshot wounds, and 133 with stab wounds. In the blunt trauma group, 16 laparotomies (8%) showed no injury and 24 (12%) showed that no repair was needed. Physical examination (68 cases) and diagnostic peritoneal lavage (DPL) (121) were used as the primary indication for laparotomy. In the stab wound group, there was a high incidence of negative or nontherapeutic operation when proximity to the abdomen or deep fascial penetration was the indication for operation. Patients sustaining gunshot wounds had a 27% incidence of negative laparotomy, with proximity being the primary indication for operation. Two deaths in the negative laparotomy group occurred due to associated injuries. Complications were minimal. DPL has decreased the number of negative operations but has increased the nontherapeutic operations. The high incidence of negative laparotomy for stab wounds shows the need for selective management rather than routine exploration.