Management Of Stab Wounds To The Anterior Abdominal Wall [abordagem Dos Ferimentos Por Arma Branca Na Parede Anterior Do Abdome]

The meeting of the Publication "Evidence Based Telemedicine - Trauma and Emergency Surgery" (TBE-CiTE), through literature review, selected three recent articles on the treatment of victims stab wounds to the abdominal wall. The first study looked at the role of computed tomography (CT) in the treatment of patients with stab wounds to the abdominal wall. The second examined the use of laparoscopy over serial physical examinations to evaluate patients in need of laparotomy. The third did a review of surgical exploration of the abdominal wound, use of diagnostic peritoneal lavage and CT for the early identification of significant lesions and the best time for intervention. There was consensus to laparotomy in the presence of hemodynamic instability or signs of peritonitis, or evisceration. The wound should be explored under local anesthesia and if there is no injury to the aponeurosis the patient can be discharged. In the presence of penetration into the abdominal cavity, serial abdominal examinations are safe without CT. Laparoscopy is well indicated when there is doubt about any intracavitary lesion, in centers experienced in this method.4117579Shaftan, G.W., Indications for operation in abdominal trauma (1960) Am J Surg, 99, pp. 657-664Biffl, W.L., Kaups, K.L., Pham, T.N., Rowell, S.E., Jurkovich, G.J., Burlew, C.C., Validating the Western Trauma Association algorithm for managing patients with anterior abdominal stab wounds: A Western Trauma Association multicenter trial (2011) J Trauma, 71 (6), pp. 1494-1502Inaba, K., Okoye, O.T., Rosenheck, R., Melo, N., Branco, B.C., Talving, P., Prospective evaluation of the role of computed tomography in the assessment of abdominal stab wounds (2013) JAMA Surg, 148 (9), pp. 810-816Sumislawski, J.J., Zarzaur, B.L., Paulus, E.M., Sharpe, J.P., Savage, S.A., Nawaf, C.B., Diagnostic laparoscopy after anterior abdominal stab wounds: Worth another look? (2013) J Trauma Acute Care Surg, 75 (6), pp. 1013-1017. , discussion 1017-8Weigelt, J.A., Kingman, R.G., Complications of negative laparotomy for trauma (1988) Am J Surg, 156 (6), pp. 544-547Lappäniemi, A., Salo, J., Haapiainen, R., Complications of negative laparotomy for truncal stab wounds (1995) J Trauma, 38 (1), pp. 54-58Morrison, J.E., Wisner, D.H., Bodai, B.I., Complications after negative laparotomy for trauma: Long-term follow-up in a health maintenance organization (1996) J Trauma, 41 (3), pp. 509-513Velmahos, G.C., Demetriades, D., Toutouzas, K.G., Sarkisyan, G., Chan, L.S., Ishak, R., Selective nonoperative management of 1,856 patients with abdominal gunshot wounds: Should routine laparotomy still be the standard of care (2001) Ann Surg, 234 (3), pp. 395-402. , discussion 402-3Clarke, D.L., Allorto, N.L., Thomson, S.R., An audit of failed non-operative management of abdominal stab wounds (2010) Injury, 41 (5), pp. 488-491Biffl, W.L., Kaups, K.L., Cothren, C.C., Brasel, K.J., Dicker, R.A., Bullard, M., Management of patients with anterior abdominal stab wounds: A Western Trauma Association multicenter trial (2009) J Trauma, 66 (5), pp. 1294-130