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Journal of the Korean Society of Traumatology 2007;20(2):106-114.
Indications for an Immediate Laparotomy in Patients with Abdominal Stab Wounds
Hyeong Ju Kim, Seong Youn Hwang, Young Cheol Choi
1Department of Emergency Medicine, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea.
2Department of Surgery, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea. masancyc@hanmir.com
복부 자상 환자에서 즉각적 개복술을 위한 적응증
김형주·황성연·최영철
성균관대학교 의과대학 마산삼성병원 응급의학교실, 외과학교실
Abstract
PURPOSE
There is little controversy that a classic indication such as hemodynamic instability or any sign of peritoneal irritation requires an immediate laparotomy in the management of abdominal stab wounds. However, omental herniation or bowel evisceration as an indication for an immediate laparotomy is controversial. The purpose of this study was to evaluate the significance of these factors as indications for an immediate laparotomy.
METHODS
The medical records of 98 consecutive abdominal stab wounds patients admitted to the Emergency Center of Masan Samsung Hospital from January 2000 to December 2006 were carefully examined retrospectively. Using multivariate logistic regression analysis, thirty-nine factors, including the classic indication and intraabdominal organ evisceration, were evaluated and were found to be associated with a need for a laparotomy. Also, the classic indication was compared with a new indication consisting of components of the classic indication and intra-abdominal organ evisceration by constructing a contingency table according to the need for a laparotomy.
RESULTS
Multivariate logistic regression analysis revealed any sign of peritoneal irritation, base deficit, and age to be significant factors associated with the need for a laparotomy (p<0.05). The sensitivity, specificity, and accuracy rates of the classic indication were 98.6%, 72.0%, and 91.8%, respectively, and those of the new indication were 93.2%, 84.0%, and 90.8%, respectively. The differences in those rates between the above two indications were not significant.
CONCLUSION
Intra-abdominal organ evisceration was not a significant factor for an immediate laparotomy. Moreover, the new indication including intra-abdominal organ evisceration was not superior to the classic indication. Therefore, in the management of abdominal stab wounds, the authors suggest that an immediate laparotomy should be performed on patients with hemodynamic instability or with any sign of peritoneal irritation.
Key Words: Stab wounds; Evisceration; Laparotomy; Abdomen


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