This journal only 2001, Number 4 Cir Gen 2001; 23 (4) Non-therapeutic laparotomy for penetrating wounds to the back and flank of the abdomen; proposal of a study algorithm Vizcarra DA, Pérez AJ, Magaña SI, Cabello PR Full text How to cite this article Language: Spanish References: 17 Page: 234-239 PDF size: 44.14 Kb. Key words: Non-therapeutic laparotomy, abdominal trauma. ABSTRACT Objective: To identify the frequency, morbidity and mortality of non-therapeutic laparotomies as a consequence of penetrating abdominal wounds to the back and flank, and to propose an algorithm for diagnosis and treatment of this type of lesions. Setting: Third level health care hospital. Patients and methods: We analyzed the incidence and morbidity of non-therapeutic laparotomies, due to penetrating trauma caused by stabbing or fire arms in patients admitted to our hospital. We reviewed surgery indications and type of complications. Results: A total of 368 exploratory laparotomies were performed, and, of these, 244 (66%) were due to firearm injuries; 124 (34%) were due to injuries caused by stabbing, of which 71 (19%) were non-therapeutic. The main indication for surgery was the suspicion of penetration with peritoneal irritation data, the main finding was hepatic lesion grade I. Frequency of complications was of 17%, the main causes were atelectasis, wound and urinary tract infections. Conclusion: Non-therapeutic laparotomies due to penetrating trauma of the abdomen to the back and flank are more frequent for stab lesions, especially if the indication for surgery is based only on subjective data. This produces a high morbidity. Therefore, it is necessary to establish a management algorithm for the precise diagnosis and treatment of this type of lesions. REFERENCES Chihombori A, Hoover EL, Phillips T, Sclafani S, Scalea T, Jaffe BM. Role of diagnostic techniques in the initial evaluation of stab wounds to the anterior abdomen, back and flank. J Natl Med Assoc 1991; 83: 137-40. Vanderzee J, Christenberry P, Jurkovich GJ. Penetrating trauma to the back and flank: A reassessment of mandatory celiotomy. Am Surg 1987; 53: 220-2. Jackson GL, Thal ER. Management of stab wounds of the back and flank. J Trauma 1979; 19: 660-4. Renz BM, Feliciano DV. Unnecessary laparotomies for trauma: a prospective study of morbidity. J Trauma 1995; 38: 350-6. Leppaniemi A, Salo J, Haapiainen R. Complications of negative laparotomy for truncal stab wounds. J Trauma 1995; 38: 54-8. Burns RK. Sariol HS, Ross SE. Penetrating posterior abdominal trauma. Injury 1994; 25: 429-31. Boyle EM Jr, Maier RV, Salazar JD, Kavacich JG, O’Keefe G, Mann FA, et al. Diagnosis of injuries after stab wounds to the back and flank. J Trauma 1997; 42: 260-5. Kirton OC, Wint D, Thrasher B, Windsor J, Echenique A, Hudson-Civetta J. Stab wounds to the back and flank in the hemodynamically stable patient: a decision algorithm based on contrast-enhanced computed tomography with colonic opacification. Am J Surg 1997; 173: 189-93. Demetriades D, Rabinowitz B, Sofianos C, Charalmabides D, Melissas J, Hatzitheofilou C, et al. The management of penetrating injuries of the back. A prospective study of 230 patients. Ann Surg 1988; 207: 72-4. Peck JJ, Berne TV. Posterior abdominal stab wounds. J Trauma 1981; 21: 298-306. Rosemurgy AS 2nd, Albrink MH, Olson SM, Sherman H, Albertini J, Kramer R, et al. Abdominal stab wound protocol: prospective study documents applicability for widespread use. Am Surg 1995; 61: 112-6. Kahn JH. The management of stab wounds of the back. J Emerg Med 1999; 17: 497-502. Albrecht RM, Vigil A, Schermer CR, Demarest GB 3rd, Davis VH, Fry DE. Stab wounds to the back flank in hemodinamically stable patients: evaluation using triple contrast computed tomography. Am Surg 1999; 65: 683-7; discussion 687-8. Thal ER, May RA, Beesinger D. Peritoneal lavage. Its unreliability in gunshot wounds of the lower chest and abdomen. Arch Surg 1984; 115: 430-3. Oreskovich MR, Carrico CJ. Stab wounds of the anterior abdomen. Analysis of a management plan using local wound exploration and quantitative peritoneal lavage. Ann Surg 1983; 198: 411-9. Fang HF, Chen RJ, Lin BC. Cell count ratio: new criterion of diagnostic peritoneal lavage for detection of hollow organ perforation. J Trauma 1998; 45: 540-4. Zantut LF, Ivatury RR, Smith RS, Kawahara NT, Porter JM, Fry WR, et al. Diagnostic and therapeutic laparoscopy for penetrating abdominal trauma: a multicenter experiencie. J Trauma 1997; 42: 825-9; discussion 829-31.