Patient selection: stab wound to the anterior abdomen and the patient is >= 16 years old. The anterior abdomen is defined as the region defined by the costal margins superiorly, anterior axillary lines laterally and groin creases inferiorly.
The patient is taken immediately to the operating room if one or more of the following is present:
(1) shock
(2) peritonitis
(3) evisceration (omental, intestinal, etc)
If none of these findings are present, then the wound is explored for evidence of peritoneal “violation”. If the peritoneum has not been entered then the patient is discharged. If the peritoneum has been violated, the the patient is admitted for observatio with serial vital signs, physical exam and laboratory testing.
Local wound exploration may involve:
(1) CT scan if the patient is obese (body mass index > 30 kg per square meter)
(2) CT scan if the wound track is long and tangential
(3) FAST (focused assessment with assessment for trauma) exam evidence of for hemoperitoneum
(4) local exam if none of the above is present
Followup during observation period – one of the following:
(1) Take the patient to the operating room if there is peritonitis or evidence of hemodynamic instability.
(2) Evaluate the patient (CT, diagnostic peritoneal lavage, at surgery) if there is a drop in hemoglobin > 3 g/dL and/or significant leukocytosis.
(3) Discharge the patient if stable and without evidence of peritoneal violation.
