Relationship between the anatomical location and the selective non-operative management of penetrating stab wounds in the abdomen

María Tudela Lerma; Fernando Turégano Fuentes; María Dolores Pérez Díaz; Cristina Rey Valcárcel; Lorena Martín Román; Cristina Ruiz Moreno; María Luz Fernández Vázquez; María Fernández Martínez

doi:10.1016/j.ciresp.2020.12.003

Relationship between the anatomical location and the selective non-operative management of penetrating stab wounds in the abdomen

Cir Esp (Engl Ed). 2021 Feb 13:S0009-739X(20)30405-X. doi: 10.1016/j.ciresp.2020.12.003. Online ahead of print.

[Article in English, Spanish]

Authors

María Tudela Lerma¹, Fernando Turégano Fuentes², María Dolores Pérez Díaz², Cristina Rey Valcárcel², Lorena Martín Román², Cristina Ruiz Moreno², María Luz Fernández Vázquez², María Fernández Martínez²

Affiliations

¹ Hospital General Universitario Gregorio Marañón, Madrid, España. Electronic address: matuler@hotmail.com.
² Hospital General Universitario Gregorio Marañón, Madrid, España.

PMID: 33593596
DOI: 10.1016/j.ciresp.2020.12.003

Abstract

Introduction: The relationship between the anatomical location of penetrating abdominal stab wounds (SW) and the rate of selective non-operative management (SNOM) based on that location is scarcely reflected in the specialized literature. Our main objective has been to assess this rate based on the anatomical location, and our results.

Methods: Retrospective review of a prospective registry of abdominal trauma from April 1993 to June 2020. The two study groups considered were the Operative Management (OM), and the SNOM, including in this one the use of diagnostic laparoscopy. Penetrating SWs in the abdomen were classified according to anatomical location.

Results: We identified 259 patients who fulfilled the inclusion criteria. SNOM was applied in 31% of the patients with a success rate of 96%, and it was more frequent in the lumbar, flank, and thoraco-abdominal regions; within the anterior abdomen it was more applicable in the RUQ, followed by the LUQ and epigastrium, respectively. An unnecessary laparotomy was done in 21% of patients, with the highest number in the epigastrium. Taking into account the unnecessary laparotomies and the rates of successful SNOM, 70,5% of lumbar, el 66,5% of epigastric, 62% of flank, and 59% of RUQ penetrating SWs could have been managed without a laparotomy.

Conclusions: SNOM of penetrating SWs in the abdomen has been safer and more applicable in those located in the lumbar, flank, epigastric, and RUQ regions.

Keywords: Abdominal trauma; Cirugía de urgencia; Emergency surgery; Herida por arma blanca; Manejo selectivo no operatorio; Penetrante; Penetrating; Selective non-operative management; Stab wound; Trauma abdominal.