[Surgical case report: diagnosis of associated abdominal lesions in penetrating injuries of the lower chest].

We discuss the way to diagnose intra-abdominal lesions caused by penetrating objects in the lower thorax. Let us call these wounds penetrating wounds. Two kinds of penetrating wounds are considered: 1. shotwounds; 2. knifewounds. 1. In shotwounds of the lower thorax there is not any non-surgical method available to find the associated intra-abdominal lesions. In these cases the results of: 1. physical examination; 2. local wound exploration; 3. echography of the abdomen and 4. peritoneal lavage cannot be trusted. Only laparotomy can show us if any associated lesion in the abdomen exists. 2. For knifewounds we can make almost the same remarks: 1. physical examination; 2. local exploration of the lesion; 3. echography of the abdomen are not to be considered as good diagnostic tools to find the associated intra-abdominal wounds. However in this situation the results of peritoneal lavage are to be trusted. Without omitting a 24 h observation of the patient the most rational criteria for a positive peritoneal lavage are red blood cell greater than 100.000/mm3; white blood cell greater than 500/mm3.