Abstract
Background
In patients with penetrating abdominal injury (PAI), haemodynamic instability and peritonitis are indications for laparotomy, but it remains uncertain whether laparotomy is indicated for evisceration, retained foreign body and pneumoperitoneum. In 1989, a review of 107 patients with PAI revealed a 78ยท5 per cent laparotomy rate, with 35 per cent considered unnecessary. The aim of this study was to review current practice in the same hospitals.
Methods
A retrospective review included case notes from 224 patients with PAI presenting to three hospitals between 2001 and 2005.
Results
Some 206 patients (92ยท0 per cent) were male and the mean age was 30ยท5 years. Aetiologies were stabbing (96ยท4 per cent), impalement (2ยท7 per cent) and gunshot wound (0ยท9 per cent). Laparotomy was performed in 48 patients (21ยท4 per cent), and was positive in 33 and unnecessary or negative in 15. Haemodynamic instability and peritonitis were strong indicators of positive laparotomy; seven of 13 laparotomies for evisceration alone were negative, as were two of four for retained foreign bodies.
Conclusion
The laparotomy rate fell from 78ยท5 to 21ยท4 per cent over 25 years. The rate of unnecessary or negative laparotomy did not change. Isolated evisceration and retained foreign body remain relative indications.