복부 자상의 치료 방법에의 접근

박지연; 정민; 이영돈; 이정남; 이운기; 박연호; 백정흠; 박흥규; 김건국; 강진모; 최상태; 이원석; 박승연

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자료유형: 학술저널

저자정보: 박지연 (가천의과대학교 길병원 외과학교실) 정민 (가천의과대학교 길병원 외과학교실) 이영돈 (가천의과대학교 길병원 외과학교실) 이정남 (가천의과대학교 길병원 외과학교실) 이운기 (가천의과대학교 길병원 외과학교실) 박연호 (가천의과대학교 길병원 외과학교실) 백정흠 (가천의과대학교 길병원 외과학교실) 박흥규 (가천의과대학교 길병원 외과학교실) 김건국 (가천의과대학교 길병원 외과학교실) 강진모 (가천의과대학교 길병원 외과학교실) 최상태 (가천의과대학교 길병원 외과학교실) 이원석 (가천의과대학교 길병원 외과학교실) 박승연 (가천의과대학교 길병원 외과학교실)

저널정보: 대한외상학회 Journal of trauma and injury : JTI Journal of trauma and injury : JTI 제23권 제2호

발행연도: 2010.1

수록면: 134 - 141 (8page)

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Purpose: A classic approach to abdominal stab wounds has been a routine laparotomy for the purpose of diagnosis or treatment. However, management protocols for abdominal stab wounds are still contentious in most trauma centers. We examined the relationship between the character of the stab wound and the injured intraabdominal organs by retrospectively analyzing the medical records of patients with abdominal stab wounds admitted to Gil hospital, and the findings for our patients are then confronted with a review of the literature. We aimed to propose proper management protocols to approach abdominal stab wounds. Methods: The medical records of all 80 patients sustaining abdominal stab wounds, admitted at the Department of Surgery, Gil Hospital, Gachon Medical School, from January 2004 to December 2008 were retrospectively reviewed. All the abdominal stab wounds were collated based on the site and the character of the injury, investigations performed on admission, results of investigations, operations performed and findings at the time of the operation. Results: The most prevalent age group was patients in their forties and the average age of the patients was 41 years for both genders. The stab wounds were most commonly located at the periumbilical area (16.9%), followed by the epigastric area (15.6%), and 18.2% of the patients had multiple wounds. The most commonly eviscerated organ was the omentum (9 out of 16 cases); 61.7% of non-eviscerated patients underwent a therapeutic laparotomy while 81.3% of eviscerated patients underwent a therapeutic laparotomy. The small bowel was the most commonly injured organ (22.7%, 17 out of 75 injuries). The review revealed a relatively common diaphragmatic injury in abdominal stab wound patients (8 cases, 10.5%). The average hospital stay was 11 days. Conclusion: This review revealed commonly eviscerated and injured intraabdominal organs in abdominal stab wound patients and their relationship with a therapeutic laparotomy. Although the management is still controversial, the authors suggest indications for an immediate laparotomy and a protocol for managing abdominal stab wounds. Hemodynamic instability and peritoneal irritation signs are definite indicators for an immediate laparotomy, but the review revealed intraabdominal organ evisceration alone not to be a statistically significant factor. In addition, the authors suggest that abnormal CT findings can be valuable for making a decision on management of hemodynamically stable stab wound patients. Further study may clarify a role for a more selective approach to operative intervention and for a more extensive use of selective observation.

#Abdominal stab wound #Evisceration #Laparotomy #Selective management

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