Selective nonoperative management of penetrating trauma of the abdomen

Abstract

Clinically evaluable patients without hemodynamic instability and/or peritonitis can safely be considered for a trial of nonoperative management. Patients with abdominal SWs undergo serial clinical examination and delayed diagnostic laparoscopy for evaluation of the left diaphragm for left thoracoabdominal injuries and CT scanning for suspected solid organ injury. Patients with GSWs to the abdomen require CT scanning to map the missile trajectory. Those with extraperitoneal trajectories and solid organ injury should undergo serial clinical examination, while those with suspicious findings for hollow-viscus injury require prompt laparotomy. Selective nonoperative management of penetrating abdominal trauma, with or without solid organ injury, with or without advanced CT technology, is still based largely on the findings from serial clinical examinations.