Optimal Follow-up Time Before Discharge in Patients with Penetrating Anterior Abdominal Stab Wound Not Requiring Laparotomy

Abstract

Patients with penetrating abdominal stab wounds who do not require emergency laparotomy should be followed up for a certain period of time for the possible need for laparotomy. The aim of this study was to determine the optimal duration of nonoperative follow-up of patients with penetrating anterior abdominal stab wounds before discharge. Emergency laparotomy was performed in patients with penetrating anterior abdominal stab wounds who were hemodynamically unstable and had signs of peritonitis on initial admission. Patients who did not require emergency laparotomy in the initial evaluation were hospitalized for observation and followed up with a physical examination for 48 h due to possible peritonitis. At the end of this period, patients who did not require laparotomy were discharged nonoperatively. Demographic characteristics of the patients and the time from admission to laparotomy were investigated and the data were analyzed. The study included 481 patients, 440(91.48%) of whom were men. Of these patients, 143(29.73%) underwent laparotomy and the remaining 338 patients were discharged nonoperatively. Of the 143 laparotomies, 67 (46.85%) were emergency, 91 (63.63%) within 4 h (including emergency laparotomy), 115 (80.42%) within 8 h, 126 (88.11%) within 12 h, 137 (95.80%) within 24 h, and 141 (98.60%) within 48 h. Two (1.40%) patients underwent laparotomy beyond 48 h. Asymptomatic patients with penetrating anterior abdominal stab wounds not requiring laparotomy can be discharged after 48 h of observation with a small missed risk of intra-abdominal injury.