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Penetrating abdominal trauma

Key sources
The following summarized guidelines for the evaluation and management of penetrating abdominal trauma are prepared by our editorial team based on guidelines from the Surgical Infection Society Europe (SIS-E/GAIS/WSES/WSIS/AAST 2023), the Eastern Association for the Surgery of Trauma (EAST/WTA/PTS 2023), the World Society of Emergency Surgery (WSES 2022), the European Association of Urology (EAU 2022), the World Society of Emergency Surgery (WSES/AAST 2020; 2019), the American College of Radiology (ACR 2019), the Eastern Association for the Surgery of Trauma (EAST 2018; 2012), and the American Urological Association (AUA 2014).
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Guidelines

1.Diagnostic investigations

Diagnostic imaging: as per WSES 2022 guidelines, obtain IV contrast-enhancing CT for detecting bowel injury.
B
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2.Diagnostic procedures

Diagnostic laparoscopy: perform local wound exploration or screening laparoscopy to investigate for peritoneal violation, when CT does not identify hard signs of bowel injury, to guide toward a laparotomy or nonoperative management. Discharge patients without peritoneal violation.
B
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  • Diagnostic peritoneal lavage

3.Medical management

Nonoperative management: as per WSES 2022 guidelines, consider offering nonoperative management at specialized centers in patients with penetrating abdominal trauma if the patient is hemodynamically compensated and cooperative. Recognize that nonoperative management might be more suitable for stab wounds when compared to gunshot wounds.
C

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4.Inpatient care

Serial clinical examinations
As per WSES 2022 guidelines:
Obtain at least 48 hours of serial clinical examinations, performed by consistent specialists or consultants, vital sign monitoring, and serial inflammatory markers testing during nonoperative management.
B
Perform serial clinical examinations as complementary to CT in guiding surgical management in trauma centers practicing nonoperative management approach.
B

5.Surgical interventions

Local wound exploration: perform local wound exploration or screening laparoscopy to investigate for peritoneal violation, when CT does not identify hard signs of bowel injury, to guide toward a laparotomy or nonoperative management. Discharge patients without peritoneal violation.
B

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  • Bowel injury repair

6.Specific circumstances

Pediatric patients
Consider performing emergency department thoracotomy in pediatric patients presenting pulseless to the emergency department following a penetrating abdominopelvic injury with signs of life.
C
Avoid performing emergency department thoracotomy in pediatric patients presenting pulseless to the emergency department following a penetrating abdominopelvic injury without signs of life.
D

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  • Patients with diaphragmatic injury

  • Patients with kidney injury

  • Patients with ureteral injury

  • Patients with bladder injury