Diagnosis of injuries after stab wounds to the back and flank.
作者信息
Boyle E M, Maier R V, Salazar J D, Kovacich J C, O'Keefe G, Mann F A, Wilson A J, Copass M K, Jurkovich G J
机构信息
Department of Surgery, Harborview Medical Center, University of Washington, Seattle 98104, USA.
出版信息
J Trauma. 1997 Feb;42(2):260-5. doi: 10.1097/00005373-199702000-00013.
BACKGROUND
Historically, patients with deep posterior wounds underwent a formal celiotomy to rule out injury. Currently, we use a policy of selective management. The purpose of this review is to evaluate our experience with selective management to identify potential areas of further improvement.
METHODS AND RESULTS
This study includes 203 patients over a 10-year period. By changing from a policy of mandatory exploration to selective management the total celiotomy rate decreased from 100 to 24% and the therapeutic celiotomy rate increased from 15 to 80%.
CONCLUSIONS
In stable patients, a diagnostic peritoneal lavage should be performed as the initial diagnostic study. When diagnostic peritoneal lavage is negative, triple contrast computed tomography should be performed to evaluate the remaining retroperitoneal structures. Any suggestion of pericolonic extravasation of contrast or air, edema, or hemorrhage must be interpreted as a positive study and prompt consideration for operative exploration.
Zotero 插件