[Selective conservatism in the management of abdominal stab wounds].

Two hundred and two consecutive patients with abdominal stab wounds in a 14-year period were analysed as follows: (1) The patients were classified into 4 categories; type I (no peritoneal penetration) 12%, type IIa (peritoneal penetration, no organ injury) plus type IIb (organ injury, no repair required) 26% and type III (organ injury, repair required) 62%. Injuries caused by kitchen-knife or violence, wounds in the lower chest or epigastrium, and harakiri-injuries (Japanese traditional method of suicide) resulted in high frequencies of type III injury. (2) Hematoemesis, hematuria, unstable hemodynamics, and signs of peritonitis were reliable indications for immediate laparotomy. Both stabography and diagnostic peritoneal lavage were unuseful as adjunctive diagnostic methods. (3) A policy of selective management in 126 patients (1981-1988), comparing with a policy of mandatory exploration in 76 patients (1975-1980), reduced unnecessary laparotomy rate from 32% to 14% (p less than 0.01). (4) Injury patterns, observed in this series and the reported series from Japanese emergency centers, were strikingly different from the American series. The author emphasize the threat of morbidity caused by delayed diagnosis in the application of selective conservatism and propose the acceptable rate of unnecessary laparotomy; less than 15%.