Diagnosis of injuries after stab wounds to the back and flank

Edward M. Boyle, Ronald V. Maier, Jorge D. Salazar, John C. Kovacich, Grant O'Keefe, Fredrick A. Mann, Anthony J. Wilson, Michael K. Copass, Gregory Jurkovich

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Background: Historically, patients with deep posterior wounds underwent a formal celiotomy to rule out injury. Currently, we use a policy of selective management. The purpose of this review is to evaluate our experience with selective management to identify potential areas of further improvement. Methods and Results: This study includes 203 patients over a 10- year period. By changing from a policy of mandatory exploration to selective management the total celiotomy rate decreased from 100 to 24% and the therapeutic celiotomy rate increased from 15 to 80%. Conclusions: In stable patients, a diagnostic peritoneal lavage should be performed as the initial diagnostic study. When diagnostic peritoneal lavage is negative, triple contrast computed tomography should be performed to evaluate the remaining retroperitoneal structures. Any suggestion of pericolonic extravasation of contrast or air, edema, or hemorrhage must be interpreted as a positive study and prompt consideration for operative exploration.

Original languageEnglish (US)
Pages (from-to)260-265
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume42
Issue number2
DOIs
StatePublished - Feb 1 1997
Externally publishedYes

Fingerprint

Stab Wounds
Peritoneal Lavage
Wounds and Injuries
Edema
Air
Tomography
Hemorrhage
Therapeutics

Keywords

  • Back
  • Diagnostic peritoneal lavage
  • Flank
  • Penetrating
  • Stab wound
  • Triple contrast computed tomography

ASJC Scopus subject areas

  • Surgery

Cite this

Diagnosis of injuries after stab wounds to the back and flank. / Boyle, Edward M.; Maier, Ronald V.; Salazar, Jorge D.; Kovacich, John C.; O'Keefe, Grant; Mann, Fredrick A.; Wilson, Anthony J.; Copass, Michael K.; Jurkovich, Gregory.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 42, No. 2, 01.02.1997, p. 260-265.

Research output: Contribution to journalArticle

Boyle, EM, Maier, RV, Salazar, JD, Kovacich, JC, O'Keefe, G, Mann, FA, Wilson, AJ, Copass, MK & Jurkovich, G 1997, 'Diagnosis of injuries after stab wounds to the back and flank', Journal of Trauma - Injury, Infection and Critical Care, vol. 42, no. 2, pp. 260-265. https://doi.org/10.1097/00005373-199702000-00013
Boyle, Edward M. ; Maier, Ronald V. ; Salazar, Jorge D. ; Kovacich, John C. ; O'Keefe, Grant ; Mann, Fredrick A. ; Wilson, Anthony J. ; Copass, Michael K. ; Jurkovich, Gregory. / Diagnosis of injuries after stab wounds to the back and flank. In: Journal of Trauma - Injury, Infection and Critical Care. 1997 ; Vol. 42, No. 2. pp. 260-265.
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AU - Maier, Ronald V.

AU - Salazar, Jorge D.

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AU - O'Keefe, Grant

AU - Mann, Fredrick A.

AU - Wilson, Anthony J.

AU - Copass, Michael K.

AU - Jurkovich, Gregory

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AB - Background: Historically, patients with deep posterior wounds underwent a formal celiotomy to rule out injury. Currently, we use a policy of selective management. The purpose of this review is to evaluate our experience with selective management to identify potential areas of further improvement. Methods and Results: This study includes 203 patients over a 10- year period. By changing from a policy of mandatory exploration to selective management the total celiotomy rate decreased from 100 to 24% and the therapeutic celiotomy rate increased from 15 to 80%. Conclusions: In stable patients, a diagnostic peritoneal lavage should be performed as the initial diagnostic study. When diagnostic peritoneal lavage is negative, triple contrast computed tomography should be performed to evaluate the remaining retroperitoneal structures. Any suggestion of pericolonic extravasation of contrast or air, edema, or hemorrhage must be interpreted as a positive study and prompt consideration for operative exploration.

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