Penetrating wounds of the abdomen: “selective abstentionism” versus systematic laparotomy

Seance of wednesday 26 february 2003 (SEANCE A DAKAR (SENEGAL))

Abstract

There is still some ongoing controversy about the management ofabdominal penetrating wounds. The aim of this study was to evaluatethe management of this type of injury at the Hospital A. Le Dantecemergency department.This retrospective study was performed over 5 years, from January1997 to January 2002. It included 90 cases of abdominal penetrat -ing wounds (88 men and 2 women) with an average age of 27. Twogroups of patients were distinguished. Group 1 comprised 61 patientswith a diagnosis of penetrating abdominal wound based onthe following findings: epiplocele, evisceration, leakage of peritonealfluid. In these patients, early laparotomy was systematic.Group 2 included 29 patients who did not present any sign of gravity,and who beneficiated from a simple closure of the wound underlocal anesthesia followed by close surveillance.The age, sex, causative agent and circumstances of injury weresimilar in both groups. The overall mortality rate was about 2.2% (2cases confined to group 1). The overall morbidity rate was about13.3% . There were 6 cases of peritonitis, of which five were ingroup 2, bringing the secondary surgery rate to 17%. Complicationsin group 1 also included 3 parietal suppuration, 2 transit delay andtwo evisceration. The rate of avoidable laparotomy was 25% ingroup 1.Early laparotomy to any penetrating wound of the abdomen allowsfor a precise evaluation of the lesions and presents an obvious medico-legal advantage, especially in aggression victims. However“selective abstentionism” decreases the number of unnecessarylaparotomies. Ultimately, there is no absolute dogmatic attitude.