Penetrating abdominal trauma.

Penetrating trauma of the abdomen no longer warrants automatic laparotomy. Reasonably accurate clinical predictors of the need for operation should first be employed. Patients who do not meet these clinical criteria undergo a selective diagnostic approach on the basis of mechanism and site of injury and the experience and expertise of the respective institution. The desire to avoid unnecessary laparotomy is laudable. Nevertheless marked morbidity or mortality caused by failure to conduct laparotomy in a timely manner can be a dreaded consequence. When clinical and diagnostic studies are unable to resolve the presence or severity of injury, laparotomy is often more prudent than expectant observation.