A CLINICAL ANALYSIS OF THE ABDOMINAL STAB WOUNDS

Yoo, Su Jin; Park, Jae Hwang

J Korean Soc Emerg Med > Volume 6(1); 1995 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 1995;6(1): 77-88.

A CLINICAL ANALYSIS OF THE ABDOMINAL STAB WOUNDS

Su Jin Yoo, Jae Hwang Park

Department of Emergency Medicine, WonKwang University School of Medicine, lksan, Korea

Published online: June 30, 1995.

ABSTRACT

Study objective
To refer the management of patients with stab wound to abdomen, because controversy still exists regarding management of patients whenever exploratory laparotomy or selective management.
Design
Retrospective study
Setting
The WonKwang university hospital emergency department during January 1st 1989 through December 31th 1994 Participants : 62 patients was admitted after abdominal stab wound Method and intervention : Charts of all patients with abdominal stab wound was reviewed to determine the result between operative management and non-operative management according to surgical indication, paracentesis, peritoneal lavage or abdominal computerized tomographic scan. Patients was discharged from emergency department or transferred to other hospital was excluded. Measurement : There were 62 patients admission to general surgery after abdominal stab wound. Sixty-one patients were alive and one patient were died. The patients grouped as operative management(A group) and non-operative management(B group). A group was 50 patients(80.6%) according to surgical indication, paracentesis, local wound exploration, or abdominal C-T scan. B group was 12 patients(19.4% ). According to clinical features, we found sex ratio(M : F, 4 : 1), 13cases in 1990, spring in 22cases(35.6%), time of injury from 20hour to next 4hour in 35cases(56.5% ), no jab in 18cases(29% ), knife in 47cases(75.8% ), epigastrium in 16cases(26% ), interval from injury to admission within 30minute in 22cases(35.5%), homicide in 49cases(79.1%). The surgical indication were peritoneal irritation(70.9%), next, in order of incidence, loss of bowel sound(53.3%), shock(32.2%), evisceration(19.4%), and free air(1.6%). In the operative group(A group), we found positive paracentesis in 10cases(83%), positive abdominal C-T finding in 5cases(45.5%), positive peritoneal lavage in 2cases(100%), but in the non-operative group(B group), negative abdominal C-T finding in 2cases(100%) and negative peritoneal lavage in 6cases(100%). The organ which most common injured was small bowel(11cases, 22%) and colon(9cases, 18%). The negative exploration was 15cases(30% )in A group, delayed operation was none. The surgical complication was 12% in A group and no in B group. The average hospital stay were 9.7days in A group and 3.8days in B group.
Conclusion
The negative operation ratio was high in operative group. These results imply that must be selective management by physical finding and use of diagnostic method including local wound exploration, diagnostic peritoneal lavage, paracentesis, abdominal sonography and abdominal C-T scan because of higher negative operative ratio.

Key words: Abdominal stab wound, Selective management.