stab wounds to anterior abdomen

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What is your comfort level?  I like wound explorations in patients that will
be still.  It doesn’t take long.  I can washout the wound and close it in 15
- 20 minutes.  The key seeing the whole wound.  You need good lighting.  If
you don't have that then go to the OR and do the same thing.  IN the OR use
your retractors see everything.  Don't guess. If the peritoneum is violated
open the patient.  If it isn't then close the wound and send the patient
home.  

Serial abdominal exams are labor intensive.  Would not use unless you have
residents and an excellent nursing staff.  Need to monitor these patients.  

I use CT a lot in abdominal trauma but not really for evaluation of the
anterior abdomen with a penetrating wound.  

My 2 cents.

Errington C. Thompson, MD, FACS, FCCM
Trauma/Surgical Critical Care
Mission Hospital
Asheville, NC
Author - A Letter to America
www.whereistheoutrage.net

 
Everyone deserves to make an informed decision
                                - Errington Thompson, MD


-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Abdullah Harthy
Sent: Wednesday, May 09, 2007 9:40 PM
To: Trauma & Critical Care mailing list
Subject: stab wounds to anterior abdomen

I was recently presenting a case scenario to a group
of surgical residents, and we had a bit of a debate on
how to manage pt.. with stab wound to the anterior
abdomen (not in the cardiac box), hemodynamically
stable, no peritonitis. Wound exploration, CT abdomen
vs. serial abdominal exam.
I'd like to know the group  practice is (considering a
lot of our patients are intoxicated with one thing or
another). I would also appreciate referrences if
available. How low is your threshold for an
explorative laprotomy.  

Abdullah Al- Harthy


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