A study done at Cook County Hospital in 1999 over an 8-year period examined this question. A total of 81 patients were admitted for abdominal stab wounds with evisceration. All patients went for exploratory laparotomy and 63 patients (78%) had an intra-abdominal injury requiring repair. While other authors have argued that the organ eviscerated should dictate need for laparotomy, there was no statistically significant difference in the need for repair in this study (omentum: 77%, viscus 80%). In 2009, a retrospective study was done in South Africa by Da Silva et al that yielded similar results. In their study, 66 patients with abdominal stab wounds with evisceration were selected. Of these patients, 57 (86%) were found to have intra-abdominal injuries requiring repair.
Of course there is an argument against immediate laparotomy in these patients. Demetriades, in his study in 1987, took far fewer patients to the OR by using a serial abdominal exam protocol. However, the complications of delayed surgery did include sepsis as well as delayed wound infection.
After reviewing the data, it is evident that although a more aggressive approach to these patients will yield a small number of negative laparotomies, it is likely more beneficial to the patient to repair injuries sooner rather than later. Waiting for peritonitis to become obvious during observation is more likely to expose the patient to perioperative complications.
This post submitted by Dr. Fred Lepore
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