Analysis of Factors to Determine Treatment Methods for Abdominal Stab Wound Patients with Peritoneal Breach According to the Results of Diagnostic Laparotomy

In abdominal penetrating injury, selective non-operative management (SNOM) is widely accepted. Even with advanced imaging, few patients undergo non-therapeutic surgery. In the present study, we analyzed factors other than clinical presentations that predicted intra-abdominal injury or would have prevented a non-therapeutic surgery. It was a retrospective analysis of data from 2016 to 2021 from the level 1 trauma center. Hemodynamically stable patients with an anterior abdominal wall stab injury diagnosed on computed tomography (CT) with no overt abdominal signs (CT-positive group) who underwent surgical management were included. The outcome measures were the number of patients with intra-abdominal injuries and patient factors predicting the intra-abdominal injury. Of the 179 patients, 42 who had peritoneal breach CT (CT positive) but had no overt abdominal signs and were hemodynamically stable were included. On further surgical exploration of this CT-positive group, only 12 had intra-abdominal injury (injury-positive group) which was the primary outcome and 30 had no intra-abdominal injury (injury negative group). Further, the injury-positive group had a lower body mass index (BMI) (22.21 SD 2.77 vs. 24.87 SD 4.04, p = 0.044), and the injury-negative group had a higher rate of self-inflicted injury (7 (58.3%) vs. 29 (96.7%), p = 0.001). In the patients with PASI who are hemodynamically stable, CT shows only peritoneal breach, and no overt physical and clinical abdominal signs of peritonitis could be safely managed with SNOM. Further, a higher BMI and self-inflicted injuries altogether could avoid an unnecessary non-therapeutic laparotomy provided used in proper clinical context.