Selective management of posterior stab wounds.

Selective management of 473 patients with stab wounds limited to the posterior abdomen was reviewed. This group was composed of predominantly young, healthy men. Laporotomy was based primarily on clinical findings. Tenderness, not localized to the area of injury, or absent or rare bowel sounds best identified patients with serious injuries. Omental protrusion was frequently associated with significant organ injury. Peritoneal lavage and local wound exploration were used infrequently. All patients with fatal injuries were operated on or died within four hours of admission. Diagnosis was delayed in five serious injuries: one diaphragmatic, three retroperitoneal colon perforations and one duodenal injury, all of which were identified and treated successfully in the initial hospital admission without any complications. Seventy-six percent of the patients never required surgery. Sixteen percent of all patients had significant organ injury, and six percent had "nonessential" laporotomy. Overall morbidity was 12 percent and mortality was 1.1 percent. The colon, liver, diaphragm, and kidneys were the most common organs injured. Thus, clinical assessment alone is a reliable means of selectively managing patients with posterior abdominal stab wounds.