Selective non-operative management of stab wounds to the posterior abdomen is safe: the Pietermaritzburg experience

Introduction: The selective non-operative management (SNOM) of stab injuries of the anterior abdomen is well established, but its application to the posterior abdomen remains controversial. Materials and methods: A retrospective review of 1013 patients was undertaken at a major trauma service in South Africa over a five-year period. Results: Ninety per cent of patients were males, and the mean age was 25 years. The mean time from injury to presentation was 4 h and 73% of all injuries were inflicted by knives. A total of 9% (93) of patients required a laparotomy [Group A] and 82% (833) were successfully observed without the need for operative intervention [Group B]. CT imaging was performed on 52 patients (5%) who had haematuria [Group C], 25 (3%) who had neurological deficits [Group D], and 10 (1%) with retained weapon injuries [Group E]. The accuracy of physical examination for identifying the presence of organ injury was 88%. All observed patients who required laparotomy declared themselves within 24 h. There were no mortalities as direct result of our current management protocol. Conclusions: Selective management based on active clinical observation and serial physical examination is safe, and when coupled with the judicious use of advanced imaging, is a prudent and reliable approach in a resource constrained environment. (C) 2015 Elsevier Ltd. All rights reserved.