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Thu May 10 05:53:40 BST 2007

Abdullah

We would do serial clinical exams, provided GCS >12. In over a thousand cases of the last four years we have only had one patient with a significant missed injury. Wound exploration is oversensitive and you end up doing way too many negative laparotomy. CT is useful for RUQ stabs / GSW where it may show a clear hepatic only tract, otherwise it and DPL are really no better than the wound exploration method, which is clearly less specific than good clinical review.

Look at the Trauma.org main site for a good overview (if I remember correctly it is in the resources section): References available there.

Regards
Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS  instructor and DSTC Cape Town Course Director
Intern program Coordinator: Surgery
M.Med (Emergency Medicine) Executive Committee member
Clinical Head (Director): Diana Princess of Wales Trauma Unit
Division of Surgery (General) Room 4064
Department of Surgical Sciences
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Abdullah Harthy
Sent: Thursday, May 10, 2007 3:40 AM
To: Trauma &amp; 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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stab wounds to anterior abdomen