Penetrating trauma to the back and flank. A reassessment of mandatory celiotomy.

The optimum management of penetrating wounds to the back and flank remains controversial. Since 1980 our institution has followed a policy of mandatory celiotomy for back and flank wounds with evidence of fascial penetration. Following this policy, 34 patients underwent celiotomy for back (8), flank (22), or combined (4) area penetrating injuries. Four patients sustained shotgun blasts, eight sustained handgun or rifle injuries, and 22 patients were stabbed. All shotgun blasts caused multiple intra-abdominal injuries and five (63%) of the eight gunshot victims had significant intra-abdominal injuries. Only one (5%) of the 22 stab victims had significant intra-abdominal injury. Four (12%) patients died, three of shotgun injuries. One patient had a small bowel obstruction 1 month after a noncontributory abdominal examination. Based on this review, the authors recommend selective management of stab wounds to the back and flank. Gunshot wounds continue to warrant mandatory exploration.