Penetrating abdominal wounds--a prospective trial of conservative treatment based on physical signs.

Between 1980-1987 605 patients with penetrating abdominal wounds were admitted to Victoria Hospital; 105 had gunshot wounds of whom 103 had laparotomies with positive findings. It is concluded that virtually all patients with gunshot wounds of the abdomen require laparotomy. The remaining 500 patients presented with stab wounds of the abdomen and were admitted to the surgical wards; of these 357 had physical signs necessitating immediate laparotomy while the remainder were observed. A further 60 observed patients required a late laparotomy and 8 of these patients developed complications; there was 1 death. The overall unnecessary laparotomy rate was 21% (105 patients) with a morbidity of 5.7%. Ninety-five patients had omentum protruding through the wound; 17 were treated conservatively without sequelae and a further 22 had negative findings at laparotomy. There were no significant differences in the morbidity and mortality rates between the conservatively treated group and those requiring immediate laparotomy. It is apparent that there is a definite place for conservative treatment of penetrating stab wounds of the abdomen even when there is protruding omentum. Cases which need particular care are those with stab wounds in and below the 5th left intercostal space and stab wounds of the back and flank. Penetrating stab wounds of the colon, irrespective of site, can be managed by simple closure in the majority of patients.