| Practice management guidelines for selective nonoperative management of penetrating abdominal trauma. | |
| | |
MedLine Citation:
|
PMID: 20220426 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND:: Although there is no debate that patients with peritonitis or hemodynamic instability should undergo urgent laparotomy after penetrating injury to the abdomen, it is also clear that certain stable patients without peritonitis may be managed without operation. The practice of deciding which patients may not need surgery after penetrating abdominal wounds has been termed selective management. This practice has been readily accepted during the past few decades with regard to abdominal stab wounds; however, controversy persists regarding gunshot wounds. Because of this, the Eastern Association for the Surgery of Trauma Practice Management Guidelines Committee set out to develop guidelines to analyze which patients may be managed safely without laparotomy after penetrating abdominal trauma. A secondary goal of this committee was to find which diagnostic adjuncts are useful in the determination of the need for surgical exploration. METHODS:: A search of the National Library of Medicine and the National Institutes of Health MEDLINE database was performed using PubMed (www.pubmed.gov). RESULTS:: The search retrieved English language articles concerning selective management of penetrating abdominal trauma and related topics from the years 1960 to 2007. These articles were then used to construct this set of practice management guidelines. CONCLUSIONS:: Although the rate of nontherapeutic laparotomies after penetrating wounds to the abdomen should be minimized, this should never be at the expense of a delay in the diagnosis and treatment of injury. With this in mind, a routine laparotomy is not indicated in hemodynamically stable patients with abdominal stab wounds without signs of peritonitis or diffuse abdominal tenderness. Likewise, it is also not routinely indicated in stable patients with abdominal gunshot wounds if the wounds are tangential and there are no peritoneal signs. Abdominopelvic computed tomography should be considered in patients selected for initial nonoperative management to facilitate initial management decisions. The majority of patients with penetrating abdominal trauma managed nonoperatively may be discharged after 24 hours of observation in the presence of a reliable abdominal examination and minimal to no abdominal tenderness. Diagnostic laparoscopy may be considered as a tool to evaluate diaphragmatic lacerations and peritoneal penetration in an effort to avoid unnecessary laparotomy. |
| | |
Authors:
|
John J Como; Faran Bokhari; William C Chiu; Therese M Duane; Michele R Holevar; Margaret A Tandoh; Rao R Ivatury; Thomas M Scalea |
Related Documents
:
|
10650596 - Issues in wound management. 9367956 - Connectivity and management of caribbean coral reefs 4194926 - The management of terminal carcinoma with oral potassium permanganate. 17670186 - Vacuum assisted closure system in the management of cervical anastomotic leakage after ... 19842306 - A cross-cultural and historical survey of tobacco use among various ethnic groups. 13922856 - Intracellular crystalline ergosterol in neurospora. |
Publication Detail:
|
Type: Journal Article; Review |
Journal Detail:
|
Title: The Journal of trauma Volume: 68 ISSN: 1529-8809 ISO Abbreviation: J Trauma Publication Date: 2010 Mar |
Date Detail:
|
Created Date: 2010-03-11 Completed Date: 2010-04-06 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 0376373 Medline TA: J Trauma Country: United States |
Other Details:
|
Languages: eng Pagination: 721-33 Citation Subset: AIM; IM |
Affiliation:
|
Division of Trauma, Critical Care, and Burns, Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio, USA. jcomo@metrohealth.org |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Abdominal Injuries
/
diagnosis*,
therapy* Humans Laparoscopy Laparotomy Peritoneal Lavage Practice Guidelines as Topic* Tomography, X-Ray Computed Wounds, Penetrating / diagnosis*, therapy* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Quality of Care Within a Trauma Center Is not Altered by Injury Type.
Next Document: The clinical significance of pneumorachis: a case report and review of the literature.