Nonoperative Management of Penetrating Injuries to the Abdomen

被引:6
作者
Benjamin E. [1 ]
Demetriades D. [1 ]
机构
[1] LAC + USC Medical Center, University of Southern California, 2051 Marengo St, Inpatient Tower C5L-100, Los Angeles, 90033, CA
关键词
Penetrating abdominal trauma; Selective nonoperative management;
D O I
10.1007/s40719-015-0014-y
中图分类号
学科分类号
摘要
Contemporary management of penetrating abdominal trauma includes potential nonoperative management in a select group of patients. Patients with hemodynamic instability or peritonitis after penetrating abdominal trauma require immediate laparotomy. Stable, evaluable patients without peritonitis, however, may be selected for a protocol of serial abdominal and laboratory examinations. Cross-sectional imaging is a useful adjunct for trajectory mapping, especially after gunshot wounds. Although many patients may be successfully managed without operation, a subset of patients selected for nonoperative management will develop clinical signs of intra-abdominal injury and required delayed laparotomy. Protocols of selective nonoperative management after penetrating abdominal trauma have been shown to be safe. The desire to avoid the morbidity of nontherapeutic laparotomy, however, must continue to be weighed against the risk of missed intra-abdominal injury and the institutional feasibility of strict adherence to a protocol of serial examinations. © 2015, Springer International Publishing AG.
引用
收藏
页码:102 / 106
页数:4
相关论文
共 26 条
[1]  
Shaftan G.W., Indications for operation in abdominal trauma, Am J Surg, 99, pp. 657-664, (1960)
[2]  
Demetriades D., Rabinowitz B., Indications for operation in abdominal stab wounds. A prospective study of 651 patients, Ann Surg, 205, 2, pp. 129-132, (1987)
[3]  
Biffl W.L., Kaups K.L., Cothren C.C., Brasel K.J., Dicker R.A., Bullard M.K., Et al., Management of patients with anterior abdominal stab wounds: a Western Trauma Association multicenter trial, J Trauma, 66, 5, pp. 1294-1301, (2009)
[4]  
Velmahos G.C., Demetriades D., Toutouzas K.G., Sarkisyan G., Chan L.S., Ishak R., Et al., Selective nonoperative management in 1,856 patients with abdominal gunshot wounds: should routine laparotomy still be the standard of care?, Ann Surg, 234, 3, pp. 395-402, (2001)
[5]  
Alzamel H.A., Cohn S.M., When is it safe to discharge asymptomatic patients with abdominal stab wounds?, J Trauma, 58, 3, pp. 523-525, (2005)
[6]  
MacLeod J., Freiberger D., Lewis F., Feliciano D., What is the optimal observation time for a penetrating wound to the flank?, Am Surg, 73, 1, pp. 25-31, (2007)
[7]  
Brown C.V., Velmahos G.C., Neville A.L., Rhee P., Salim A., Sangthong B., Et al., Hemodynamically “stable” patients with peritonitis after penetrating abdominal trauma: identifying those who are bleeding, Arch Surg, 140, 8, pp. 767-772, (2005)
[8]  
Leppaniemi A., Salo J., Haapiainen R., Complications of negative laparotomy for truncal stab wounds, J Trauma, 38, 1, pp. 54-58, (1995)
[9]  
Renz B.M., Feliciano D.V., Unnecessary laparotomies for trauma: a prospective study of morbidity, J Trauma, 38, 3, pp. 350-356, (1995)
[10]  
Renz B.M., Feliciano D.V., The length of hospital stay after an unnecessary laparotomy for trauma: a prospective study, J Trauma, 40, 2, pp. 187-190, (1996)