a. Patients who are hemodynamically unstable
or who have diffuse abdominal tenderness should be taken emergently for
laparotomy (Level 1)
b. Patients who are hemodynamically stable
with an unreliable clinical examination (i.e., brain injury, spinal cord
injury, intoxication, or need for sedation or anesthesia) should have further
diagnostic investigation done for intraperitoneal injury or undergo exploratory
laparotomy (Level 1).
c. A routine laparotomy is not indicated in
hemodynamically stable patients with abdominal stab wounds without signs of
peritonitis or diffuse abdominal tenderness (away from the wounding site) in
centers with surgical expertise (Level 2).
d. A routine laparotomy is not indicated in
hemodynamically stable patients with abdominal gunshot wounds if the wounds are
tangential and there are no peritoneal signs (Level 2).
e. Serial physical examination is reliable in
detecting significant injuries after penetrating trauma to the abdomen, if
performed by experienced clinicians and preferably by the same team (Level 2).
f. In patients selected for initial
non-operative management, abdominopelvic computed tomography should be strongly
considered as a diagnostic tool to facilitate initial management decisions (Level
2).
g. Patients with penetrating injury
isolated to the right upper quadrant of the abdomen may be managed without
laparotomy in the presence of stable vital signs, reliable examination and
minimal to no abdominal tenderness (Level 3).
h. The vast majority of patients with penetrating
abdominal trauma managed non-operatively may be discharged after
twenty-four hours of observation in the presence of a reliable abdominal
examination and minimal to no abdominal tenderness (Level 3).
i. Diagnostic laparoscopy may be considered as a tool to
evaluate diaphragmatic lacerations as well as peritoneal penetration
(Level 2).
Como JJ, Bokhari F, Chiu WC, Duane TM, Holevar MR, Tandoh MA, Ivatury RR,
Scalea TM. Practice management guidelines for selective nonoperative management
of penetrating abdominal trauma. J Trauma. 2010 Mar;68(3):721-33.
Updated 8-17-17
