Selective non-operative management of stab wounds to the posterior abdomen is safe: the Pietermaritzburg experience

IntroductionThe selective non-operative management (SNOM) of stab injuries of the anterior abdomen is well established, but its application to the posterior abdomen remains controversial.Materials and methodsA retrospective review of 1013 patients was undertaken at a major trauma service in South Africa over a five-year period.ResultsNinety per cent of patients were males, and the mean age was 25 years. The mean time from injury to presentation was 4 h and 73% of all injuries were inflicted by knives. A total of 9% (93) of patients required a laparotomy [Group A] and 82% (833) were successfully observed without the need for operative intervention [Group B]. CT imaging was performed on 52 patients (5%) who had haematuria [Group C], 25 (3%) who had neurological deficits [Group D], and 10 (1%) with retained weapon injuries [Group E]. The accuracy of physical examination for identifying the presence of organ injury was 88%. All observed patients who required laparotomy declared themselves within 24 h. There were no mortalities as direct result of our current management protocol.ConclusionsSelective management based on active clinical observation and serial physical examination is safe, and when coupled with the judicious use of advanced imaging, is a prudent and reliable approach in a resource constrained environment.