Penetrating stab wounds to the abdomen: Results in our secondary care center

Abstract

INTRODUCTION: Criminal incidents in cities receiving internal and external immigration can be more frequent than in other cities. As we are working in such a city, we frequently encounter trauma patients in the emergency room. The aim of this study was to scrutinize the outcomes of penetrating stab wounds to the abdomen and discuss the results achieved in our hospital, a secondary care center, in comparison with studies in the literature. METHODS: Files in the electronic data bank of patients who presented to our emergency room with stab wounds were examined. Those treated in the emergency room with simple medical intervention, patients with no penetrating wound to the abdomen, and patients younger than 18 years old were excluded from the study. Gender, age, location and type of wound, vital signs, laboratory parameters, radiological examinations, and pre- and postoperative results of 284 patients who underwent laparotomy were recorded. RESULTS: Laparotomy was performed on 284 patients included in the study. The procedure was prescribed in 12 patients for positive findings requiring peritoneal lavage, in 44 patients for findings of severe peritonitis, in 112 patients for wound exploration, in 36 patients for omental or organ evisceration, in 32 patients for shock or disruption of vital signs, and in 48 patients due to organ injury and/ or generalized fluid detected in CT. While organ injury was present in 110 of 284 patients, 174 patients underwent negative laparotomy 102 and non-therapeutic surgical procedure 72 . CONCLUSION: The rate of negative and non-therapeutic laparotomy was 61.26%. This is higher than in other studies in the literature. The reason may be problems related to the institution being a secondary care center or that surgeons decided to perform laparotomy more frequently due to increased medico-legal concerns.

Keywords

• Stab wounds
• penetrating wound to abdomen
• negative laparotomy
• unnecessary laparotomy

Batına nafiz delici kesici alet yaralanmaları: İkinci basamak sağlık merkezi olan hastanemizin sonuçları

Abstract

AMAÇ: Sürekli iç ve dış göç alan şehirlerde kriminal olaylar diğer şehirlere göre daha sık olabilir.Bu özellikleri taşıyan bir kentte çalışıyoruz dolayısıyla acil serviste sıkça travma hastalarıyla karşılaşıyoruz.Bu çalışmada batına nafiz delici-kesici alet yaralanmalarının sonuçlarını irdelemek ve ikinci basamak sağlık merkezi olan hastanemizin sonuçlarını literatür eşliğinde tartışmayı amaçladık. YÖNTEM: Hastanemizin acil servisine delici- kesici alet yaralanması nedeniyle başvuran hastaların dosyaları elektronik veri bankası kullanılarak incelendi. Basit tıbbi müdahale ile acilde tedavi edilenlerle batına nafiz olmayan hastalar ve 18 yaş altı hastalar çalışmaya alınmadı. Laparotomi yapılan 284 hastanın cinsiyeti,yaşı, yaralanma şekli,lokalizasyonu, vital bulguları, laboratuvar parametreleri,radyolojik tetkikleri, ameliyat öncesi ve ameliyat sonrasındaki bulgular kaydedildi. BULGULAR: Çalışmaya alınan 284 hastaya laparotomi yapıldı. Laparotomi kararı 12 hastada peritoneal lavaj pozitif olduğunda,44 hastada ciddi pertonit bulguları olduğunda,112 hastaya yara eksprolasyonu sonucunda,36 hastada omentum veya organ eviserasyonu olduğunda,32 hastada şok veya vital bulgularının stabilitesinin bozulmasından dolayı ve 48 hastada bilgisayarlı tomografide organ yaralanması ve/veya yaygın sıvı tespit edildiğinde laparotomi yapıldı.Ameliyat edilen 284 hastanın 110 unda organ yaralanması olmasına rağmen 174 hasta da negatif laparotomi 102 ve nonterapötik 72 cerrahi işlem yapıldı. SONUÇ: Çalışmamızda negatif laparotomi ve nonterapotik laparotomi oranımız %61.26 idi. Bu oran literatürdeki çalışmalara göre fazlaydı.Bundan ikinci basamak bir sağlık merkezi oluşumuzdan kaynaklanan problemlerin olabileceği ve artan medikolegal sorunlardan dolayı cerrahların laparotomi kararını daha sık almalarının etkili olduğunun sonucuna vardık.

Keywords

• Delici-kesici alet yaralanması
• batına nafiz yaralanma
• negatif laparotomi
• gereksiz laparotomi

References

1. Ertekin C, Yanar H, Taviloğlu K, Güloğlu R, Alimoğlu O. Un- necessary laparatomy by using physical examination and dif- ferent diagnostic modalities for penetrating abdominal stab wounds. Emerg Med J 2005:22:790-4.
2. Alimoğlu O. Laparoscopy in penetrating abdominal trauma. Eur surg 2005:37:28-32.
3. Exadaktylos A, Stettbacher A, Edul S, Nichols A, Bau- tz P. Succesful management of stab wounds with clinical evaluatşon :experience of an South –African trauma unit with consecutive patients. Unfallechirurg 2013;106:215-9.
4. Soffer D, McKenney MG, Cohn S, Garcia-Roca R, Namias N, Schulman C, Lynn M, Lopez P. Aprospective evaluation of ultrasonografy for the diagnosis of penetrating torso injury. J Trauma 2004:56:953-9.
5. Inaba K, Demetriades D. The nonoperative management of penetrating abdominal trauma. Adv Surg 2007:41:51-62.
6. Rezende-Neto JB, Vieita HM Jr, Rodrigues Bde L, Rizoli S, Nascimento B, Fraga GP. Management of stab wounds to the anterior abdominal wall. Rev Col Bras Cir 2014.Jan- Feb:41 1 :75-9.
7. Yıldız MK. Analysis of 120 patient with abdominal stab wound focusing diagnostic role of fast. Int J Clin Exp Med :7 5 :1386-90.
8. Hershkovitz Y, Shohat S, Kessel B, Schecter WP, Beicker A, Jeroukhimov I. Selective management of multiple ante- rior abdominal stab wounds: Is it safe? Isr Med Assoc J 2019 May:5 21 :330-2.

9. Bukur M, İnaba K, Barmparas G, DuBose G JJ, Lam L, Branco BC, Lustenberger T, Demetriades D. Sel-inflicted penetrating injuries at a Level I Trauma Center. Injury 2011 May:42 5 :474-7.
10. Clarke DL, Allorto NL, Thomson SR. An audit of failed non-operative management of abdominal stab wounds. Injury :41:488-91.
11. Leppaniemi AK, Haapiainen RK. Selective nonopererative management of abdominal stab wounds: Prospective rand- omized study. World J Surg 1996:20:1101-5.
12. Nishimura T, Sakata H, Yamada T, Terashima M, Shirai K, Yamada İ, Kotani J. Different patterns in abdominal stab wound in the self-inflicted and assaulted patients: An obser- vational analysis of single center experience. Kobe J Med Sci :63 1 :E17-E21.
13. Como JJ, Bokhari F, Chiu WC, Duane TM, Holevar MR, Tandoh MA, Ivatury RR, Scalea TM. Practice management guidelines for selective nonoperative management of pen- etrating abdominal trauma.2010:68:721-33.
14. Sanei B, Mahmoudieh M, Talebzadeh H, Shahabi Shah- miri S, Aghaei Z. Do Patients with penetrating abdominal stab wounds require laparatomy? Arch Trauma Res 2013:2 1 :21-5.
15. Ohene-Yeboah M, Dakubo JCB, Boakye F, Naeder SB. Pen- etrating abdominal injuries in adults seen at two teaching hos- pitals in Ghana. Ghana Med J 2010:44:103-8.
16. Thacker LK, Parks J, Thal ER. Diagnostic peritoneal lav- age: Is 100.000 RBCs a valid figure for penetrating abdominal trauma ? J Trauma 2007:62:853-7.
17. Cotren CC, Moore EE, Warren FA, Kashuk JL, Biffl WL, Johnson JL. Lokal wound exploration remains a valuable tri- age tool for the evaluation of anterior abdominal stab wounds. Am J Surg 2009:198:223-6.
18. Sugrue M, Balogh Z, Lyynch J, Bardsley J, Sisson G, Weigelt J. Guidelines for the management of haemodynamically stable patients with stab wounds to the anterior abdomen. ANZJ Surg :77 8 :614-20.
19. Ertan T, Sevim Y, Sarigoz T, Topuz O, Tastan B. Benefits of CT tractography in evaluation of anterior abdominal stab wounds. Am J Emerg Med 2015:33 9 :1188-90.
20. Oguz B. Abdominal Traumas.Turkiye Klinikleri J Radiol- Special Topics.2011:4:151-62.
21. Vafei A, Heidari K, Saboorizadeh A, Akhtari AS. Diagnostic accuracy of abdominal wall ultrasonography and local wound exploration in predicting the need for laparatomy following stab wound. Emerg Tehran 2017:5 1 :e34.
22. Barbois S, Abba J, Gigard S,Q Uesada JL, Pirvu A, Waroquet PA, Reche F, Risse O, Bouzat P, Thony F, Arvieux C. Management of penetrating abdominal and thoraco-abdominal wounds: A retrospective study of 186 patients. J Visc Surg 2016:153 4Supp :69-78.
23. Kevric J, O’Reilly GM, Gocentas RA, Hasip O, Pilgrim C, Mitra B. Management of haemodynamically stable patients with penetrating abdominal stab injuries: Review of practice at an Australian major trauma centre. Eur j Trauma Emerg Surg 2015;42 6 :671-5.
24. Yucel M, Bas G, Ozpek A, Basak F, Sisik A, Acar A, Altun Ozdemir B, Yuksekdag S, Alimoglu O. The predictive value of physical examination in the decision of laparatomy in penetrating anterior abdominal stab injury. Int.J Clin Exp Med 2015:8 7 :1185-92.
25. Osinowo AO, Olusoji OO, Adesanya AA. Abdominal stab wounds in Lagos: A review of fifty cases. Niger Postrgrad Med J 2016:23 2 :86-92