Selective Management of Stab Wounds of the Abdomen

THE management of the patient with a stab wound of the abdomen has, in most institutions, been rather standardized in the past two decades. Based on the experiences of World War II and Korea, patients with a suspected intraperitoneal injury due to perforating trauma were subjected to immediate laparotomy.1,2There is little disagreement that laparotomy is mandatory in the treatment of perforating high velocity bullet or missile injuries, either in military or in civilian life. However, the application of the principle of immediate surgery to the penetrating abdominal stab wound seen so often in civilian life has not met with unqualified success. At the heart of the matter is the fact that a disturbingly high proportion of patients subjected to laparotomy require no specific surgical repair,3presumably because the viscera tend to slide away from the advancing point of the stabbing instrument. Furthermore, these patients often constitute considerable