INTRODUCTION:Pneumoperitoneum on chest radiograph (CXR) following abdominal stab wounds (SW) is generally considered as surrogate evidence of viscus perforation and an absolute indication for laparotomy. The exact yield of this radiographic finding is unknown. MATERIALS AND METHODS:A retrospective study was conducted on all patients who presented with abdominal SW with no peritoneal signs but had pneumoperitoneum alone who underwent mandatory laparotomy from December 2012 to October 2020 at a major trauma centre in South Africa. RESULTS:During the 8-year study period, 55 patients were included (91% male, mean age: 24 years). Laparotomy was positive in 67% (37/55). Of the 37 positive laparotomies, 28 (76%) were considered therapeutic and the remaining 9 (24%) were nontherapeutic. The negative laparotomy rate was 33%. A total of 52 organ injuries were identified at laparotomy in the 37 positive laparotomies. Twenty-five per cent (14/55) of patients experienced complications. The complication rate of the subgroup of 18 patients who had a negative laparotomy was 33% (6/18). Two per cent (1/55) of all 55 patients required intensive care admission. The mean length of hospital stay was 6 days. There were no mortalities in this cohort. CONCLUSIONS:Pneumoperitoneum alone in patients with no peritoneal signs on initial assessment following abdominal SW cannot be considered an absolute indication for operative exploration. Up to one third of patients have no intra-abdominal injuries. This specific subgroup of patients can potentially be managed by a selective non-operative management approach.

译文

简介:腹部刺伤(SW)后胸部X光片(CXR)气腹通常被认为是脏器穿孔的替代证据,是剖腹手术的绝对指征。射线照相结果的确切产量尚不清楚。
材料与方法:回顾性研究了2012年12月至2020年10月在南非一家主要创伤中心接受腹腔镜手术但无腹膜体征但仅进行气腹的患者。
结果:在为期8年的研究期内,纳入了55例患者(男性占91%,平均年龄:24岁)。开腹手术阳性率为67%(37/55)。在37例积极的腹腔镜手术中,有28例(76%)被认为是治疗性的,其余9例(24%)是非治疗性的。开腹手术阴性率为33%。在37例阳性剖腹手术中,在剖腹手术中共发现52例器官损伤。 25%(14/55)的患者出现并发症。剖腹手术阴性的18例患者亚组的并发症发生率为33%(6/18)。 55名患者中有2%(1/55)需要重症监护。平均住院时间为6天。在这个队列中没有人死亡。
结论:腹部SW术后初步评估时无腹膜体征的患者仅凭气腹不能视为手术探查的绝对指征。多达三分之一的患者没有腹腔内受伤。可以通过选择性的非手术管理方法来管理患者的这一特定亚组。

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