Penetrating abdominal injuries: the Jamaican experience - abstract

ABSTRACT

One hundred and twelve patients with penetrating abdominal injuries were reviewed at the Kingston Public Hospital, Jamaica, over a twelve month period from January 1, 1992 to December 31, 1992. This review included injuries resulting from stab wounds and gunshot wounds. Thirty-seven (33 percent) patients sustained gunshot wounds to the abdomen with 10 deaths, resulting in a mortality of 27 per cent. Seventy-five (67 percent) patients had stab wounds with 7 deaths, resulting in a mortality rate of 9 per cent. Patients with stab wounds were treated using a protocol of selective conservatism. Of the 68 surviving patients with stab injuries, 41 (60 percent) were observed and 27 (40 percent) explored, with negative laparotomy being performed in 5 (12 percent) patients. In both groups of patients with stab and gunshot injuries, there was a predominance of males, with a male to female ratio of 10 1, and with 88 per cent of the group between the ages of 16 and 35 years. A decision to perform laparotomy was based entirely on clinical assessment. No use was made of diagnostic peritoneal lavage, stabograms or local wound exploration. We conclude that few diagnostic procedures are necessary in patients with suspected abdominal injuries to determine whether penetration has taken place. The decision to perform exploratory surgery can be based exclusively on clinical criteria. Mandatory laparotomy for gunshot injuries with signs of peritonitis is recommended. Omental evisceration, or other signs of peritoneal penetration, do not warrant mandatory exploration in the absence of peritonitis (AU)