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Revista Colombiana de Cirugía
Print version ISSN 2011-7582
Abstract
GOMEZ-BOTERO, Juliana; RESTREPO-JARAMILLO, Mónica and MORALES-URIBE, Carlos Hernando. Value of the physical examination in the diagnosis of intra-abdominal lesion in penetrating abdominal stab wounds. rev. colomb. cir. [online]. 2018, vol.33, n.1, pp.52-61. ISSN 2011-7582. https://doi.org/10.30944/20117582.47.
Introduction:
The purpose of this study was to determine the value of the physical examination supported by imaging in patients with penetrating abdominal wounds in diagnosing intra-abdominal injury and to select candidates for nonoperative management.
Materials and methods:
Analysis of a database of 559 patients over 15 years of age presenting with penetrating abdominal trauma at a fourth level of care hospital.
Results:
Emergency exploratory laparotomy was performed in 290 patients (51.4%), of whom 38 (13.1%) were non-therapeutic laparotomies. The sensitivity and specificity of the physical examination for the emergent surgical decision was 99.6% and 80.99%, respectively. The remaining patients (47.7%) underwent clinical observation with repeated physical examination. During the nonoperative management, 72 patients (26.8%) were taken to surgery based on findings in the physical examination. Of this group, only 11% of laparotomies were non-therapeutic. One hundred and ninety-seven (73.2%) patients were discharged with an observation period of no less than 24 hours. In this group of patients, the sensitivity of the physical examination was 98.46% and specificity was 96.08%.
Conclusions:
Our experience in the management of patients with abdominal stab wounds supports physical examination as a highly sensitive and specific diagnostic method for the diagnosis of intra-abdominal injury. Nonoperative management is a therapeutic alternative, avoiding unnecessary laparotomies and increased morbidity and mortality.
Keywords : Abdominal injuries; wounds, penetrating; physical examination; tomography; laparotomy..