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2016, Number 1

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Revista Cubana de Cirugía 2016; 55 (1)

Laparotomy criteria assessment in abdominal stab wounds

López AY, Fernández GA, Sánchez RGE

Language: Spanish
References: 28
Page: 1-11
PDF size: 136.17 Kb.


ABSTRACT

Introduction: penetrating traumatic lesions of the abdomen usually leads to damage in the abdominal cavity from a wound caused with a white weapon or other sharp-piercing object. This circumstance constitutes a health problem and one of the most common reasons for emergency consultation in surgery. This type of lesions was the fifth leading cause of death for both sexes in Cuba in 2014.
Objective: to evaluate the criteria indicative of laparotomy in patients with abdominal wounds caused with a white weapon.
Method: a diagnostic modalities assessment study was carried out in patients who underwent exploratory laparotomy for abdominal wound caused by a white weapon. The target group was made up by the patients with this type of lesions. The sample consisted of surgery patients (n= 80). Several clinical and complementary elements indicative of laparotomy were assessed before the possibility of significant organic lesions.
Results: the average age was 32 years, with a predominance of males (91.3 %). 41.3% of the patients showed exogenous intoxication signs, only 51.25% of laparotomies were therapeutic ones. The presence of hypovolemic shock (84.2 %), clinical signs of ongoing bleeding (82.4 %) and obvious gastrointestinal tract perforation (90.9 %) showed better sensitivity, specificity and positive predictive values. Among the complementary tests, laparoscopy showed values of sensitivity (89.5 %) and specificity (81.8 %) higher than the others.
Conclusions: hypovolemic shock, signs of ongoing bleeding and signs of obvious gastrointestinal tract perforation, and laparoscopy showed the best results as criteria indicative of laparotomy in abdominal stab wounds.


REFERENCES

  1. García Gutiérrez A. Traumatismos del abdomen. En: García Gutiérrez A, Pardo Gómez G, editores. Cirugía tomo II. La Habana: Editorial Ciencias Médicas; 2006. p. 648-77.

  2. Arellano Martínez P, Girón Villalobos E, Mejía Consuelos G, Carballo Cruz FJ, Espinosa Mendoza A, Basilio Olivares A. Laparotomía no terapéutica en trauma penetrante de abdomen anterior: Experiencia en el Hospital Balbuena. Tram Am Lat. 2012;2(2):83-7.

  3. Infante Carbonell MC, Cabrera Salazar J, Puertas Álvarez JF. Morbilidad y mortalidad por traumatismo con lesión visceral. MEDISAN. 2010;14(7):968-75.

  4. Ministerio de Salud Pública, Dirección Nacional de Registros Médicos y Estadísticas de Salud. Anuario Estadístico de Salud 2014. Edición Especial. La Habana: MINSAP; 2015, Abr. 31

  5. Leppäniemi AK, Voutinainen PE, Haapiainen RK. Indications for early mandatory laparotomy in abdominal stab wounds. Br J Surg. 1999;86:76-80.

  6. Taviloglu K. When to operate on abdominal stab wounds. Scand J Surg. 2002;91:58–61.

  7. Navsaria PH, Berli JU, Edu S, Nicol AJ. Non-operative management of abdominal stab wounds – an analysis of 186 patients. SAJS. 2007;45(4):128-32.

  8. Vizcarra Díaz A, Pérez Aguirre J, Magaña Sánchez I, Cabello Pasini R. Laparotomía no terapéutica en trauma penetrante de abdomen en dorso y flanco; propuesta de algoritmo de estudio. Cir Gen. 2001;23(4):234-9.

  9. Ertekin C, Yanar H, Taviloglu K, Guloglu R, Alimoglu O. Unnecessary laparotomy by using physical examination and different diagnostic modalities for penetrating abdominal stab wounds. Emerg Med J. 2005;22:790–94.

  10. Zafar SN, Rushing A, Haut ER, Kisat MT, Villegas CV, Chi A, et al. Outcome of selective non-operative management of penetrating abdominal injuries from the North American National Trauma Database. Br J Surg. 2012;99(1):155-64.

  11. Biffl WL, Kaups KL, Pham TN, Rowell SE, Jurkovich GJ, Burlew CC, et al. Validating the Western Trauma Association algorithm for managing patients with anterior abdominal stab wounds: a Western Trauma Association multicenter trial. J Trauma. 2011 Dec;71(6):1494-502.

  12. Paterson-Brown S. Abdominal trauma. En: Ellis BW, Paterson-Brown, editores. Hamilton Bailey´s Emergency Surgery. Londres: Arnold Publishers; 2000. p.446-71.

  13. Aldemir M, Taçyildiz I, Girgin S. Predicting factors for mortality in the penetrating abdominal trauma. Acta Chir Belg. 2004;104(4):429-34.

  14. Ohene-Yeboah M, Dakubo JC, Boakye F, Naeeder SB. Penetrating abdominal injuries in adults seen at two teaching hospitals in Ghana. Ghana Med J. 2010;44(3):103-8.

  15. Rezende-Neto JB, Machado Vieira H, de Lima Rodrigues B, Rizoli S, Nascimento B, Pereira Fraga G. Management of stab wounds to the anterior abdominal wall. Rev Col Bras Cir. 2014;41(1):75-9.

  16. Sanei B, Mahmoudieh M, Talebzadeh H, Shahabi Shahmiri S, Aghaei Z. Do patients with penetrating abdominal stab wounds require laparotomy? Arch Trauma Res. 2013;2(1):21-5.

  17. Demetriades D, Rabinowitz B. Indications for operation in abdominal stab wounds. Ann Surg. 1987;205(2):129-32.

  18. Hoffmann C, Goudard Y, Falzone E, Leclerc T, Planchet M, Cazes N, et al. Management of penetrating abdominal trauma: what we need to know? Ann Fr Anesth Reanim. 2013; 32(2):104-11.

  19. Yücel M, Özpek A, Yüksekdağ S, Kabak İ, Başak F, Kılıç A, et al. The management of penetrating abdominal stab wounds with organ or omentum evisceration: The results of a clinical trial. Ulusal Cer Derg. 2014;30:207-10.

  20. da Silva M, Navsaria PH, Edu S, Nicol AJ. Evisceration Following Abdominal Stab Wounds: Analysis of 66 Cases. World J Surg. 2009;33:215–9.

  21. Nicholson K, Inaba K, Skiada D, Okoye O, Lam L, Grabo D, et al. Management of patients with evisceration after abdominal stab wounds. Am Surg. 2014;80(10):984-8.

  22. Biffl WL, Moore EE. Management guidelines for penetrating abdominal trauma. Curr Opin Crit Care. 2010 Dec;16(6):609-17.

  23. Yıldız KM, Ozkan E, Odabaşı HM, Eriş C, Günay E, Abuoğlu HH, et al. Analysis of 120 patients with abdominal stab wound focusing on diagnostic role of fast. Int J Clin Exp Med. 2014;7(5):1386-90.

  24. Pacheco AM. Trauma de abdomen. Rev Med Clin Condes. 2011;22(5):623-30.

  25. Lee GJ, Son G, Yu BC, Lee JN, Chung M. Efficacy of computed tomography for abdominal stab wounds: a single institutional analysis. Eur J Trauma Emerg Surg. 2015;41:69–74.

  26. Berardoni NE, Kopelman TR, O'Neill PJ, August DL, Vail SJ, Pieri PG, et al. Use of computed tomography in the initial evaluation of anterior abdominal stab wounds. Am J Surg. 2011;202(6):690-5.

  27. Shah M, Galante JM, Scherer LA, Utter GH. The utility of laparoscopic evaluation of the parietal peritoneum in the management of anterior abdominal stab wounds. Injury. 2014;45(1):128-33.

  28. O'Malley E, Boyle E, O'Callaghan A, Coffey JC, Walsh SR. Role of laparoscopy in penetrating abdominal trauma: a systematic review. World J Surg. 2013;37(1):113-22.




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