Comparison of routine laparotomy results performed by solo surgeons with suspicious computed tomography and inflammatory markers in penetrating abdominal stab wounds in a suburban area: a retrospective cohort of 91 patients

Background: One of the most encountered challenges in trauma is predicting an intraabdominal hollow viscus injury or foreseeing a nontherapeutic laparotomy in patients with penetrating abdominal stab injuries. Suspicious computed tomography (CT) findings like free air and free fluid can leave surgeons in doubt about an injury’s presence. This study aimed to compare the therapeutic and nontherapeutic laparotomy results in patients with penetrating abdominal stab wounds who had suspicious intraabdominal hollow viscus injury CT findings. Methods: Retrospective and single-center cohort of all patients with penetrating abdominal stab wounds between January 2012 and January 2023 in Gebze Fatih State Hospital were evaluated. All patients had CT evaluation and complete blood count (CBC) and then underwent laparotomy. The laparotomies were classified as therapeutic or nontherapeutic and the patients were grouped according to the results.We then analyzed the diagnostic value of CT and initial CBC on laparotomy. Results: A total of 91 patients with penetrating abdominal stab wound who underwent laparotomy were included in the study. Of the 91 patients, 56 (61.5%) had nontherapeutic laparotomies, and 35 (38.4%) had therapeutic laparotomies for hollow viscus injury. The CT findings of intraabdominal free air or fluid were present in all patients but were not significant predictors of hollow viscus injury (p value, 0.06, 0.09, respectively). The initial CBC values, neutrophil/lymphocyte ratio and platelets/lymphocyte ratio were also not significant predictors (p-value, 0.49, 0.37, respectively). Conclusions: In this retrospective study of abdominal penetrating stab wound management, we were not able to use the CT and CBC to distinguish the injuries that require therapeutic laparotomy for hollow viscus injury.

Penetrating; Stab; Trauma; Computed tomography; Nontherapeutic laparotomy

[1] Martin MJ, Brown CVR, Shatz DV, Alam HB, Brasel KJ, Hauser CJ, et al. Evaluation and management of abdominal stab wounds: a Western trauma association critical decisions algorithm. The Journal of Trauma and Acute Care Surgery. 2018; 85: 1007–1015.

[2] Saar S, Jorgensen J, Lemma AN, Gaarder C, Naess PA, Leppäniemi A, et al. Selective non-operative management of penetrating abdominal injuries at Northern European trauma centers: the NordiPen study. European Journal of Trauma and Emergency Surgery. 2022; 48: 2023–2027.

[3] Como JJ, Bokhari F, Chiu WC, Duane TM, Holevar MR, Tandoh MA, et al. Practice management guidelines for selective nonoperative management of penetrating abdominal trauma. The Journal of Trauma. 2010; 68: 721–733.

[4] Obadiel YA, Albrashi A, Allahabi N, Sharafaddeen M, Ahmed F. Outcomes of nonoperative management of penetrating abdominal trauma injury: a retrospective study. Cureus. 2024; 16: e58599.

[5] Akgul NC, Erbil OA, Celik Y. Penetrating abdominal stab and gunshot injuries: 10-year experience of a secondary public hospital located in a suburban area with solo surgeons. Northern Clinics of Istanbul. 2024; 11: 184–190.

[6] Yucel M, Yildiz A, Basak F. The role of leukocytes in predicting whether laparotomy is required in patients with penetrating abdominal stab wound. Surgery. 2022; 171: 549–554.

[7] El-Menyar A, Mekkodathil A, Al-Ansari A, Asim M, Elmenyar E, Rizoli S, et al. Platelet-lymphocyte and neutrophil-lymphocyte ratio for prediction of hospital outcomes in patients with abdominal trauma. BioMed Research International. 2022; 2022: 5374419.

[8] Kong V, Cheung C, Elsabagh A, Rajaretnam N, Varghese C, Bruce J, et al. Radiographic pneumoperitoneum following abdominal stab wound is not an absolute indication for mandatory laparotomy—a South African experience. Injury. 2021; 52: 253–255.

[9] Thorisdottir S, Oladottir GL, Nummela MT, Koskinen SK. Diagnostic performance of CT and the use of GI contrast material for detection of hollow viscus injury after penetrating abdominal trauma. Experience from a level 1 Nordic trauma center. Acta Radiologica. 2020; 61: 1309–1315.

[10] Jawad H, Raptis C, Mintz A, Schuerer D, Mellnick V. Single-contrast CT for detecting bowel injuries in penetrating abdominopelvic trauma. American Journal of Roentgenology. 2018; 210: 761–765.

[11] Uzunosmanoğlu H, Çorbacıoğlu ŞK, Çevik Y, Akıncı E, Hacıfazlıoğlu Ç, Yavuz A, et al. What is the diagnostic value of computed tomography tractography in patients with abdominal stab wounds? European Journal of Trauma and Emergency Surgery. 2017; 43: 273–277.

[12] Butt MU, Zacharias N, Velmahos GC. Penetrating abdominal injuries: management controversies. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2009; 17: 19.

[13] van Haarst EP, van Bezooijen BP, Coene PP, Luitse JS. The efficacy of serial physical examination in penetrating abdominal trauma. Injury. 1999; 30: 599–604.

[14] Saksobhavivat N, Shanmuganathan K, Boscak AR, Sliker CW, Stein DM, Bodanapally UK, et al. Diagnostic accuracy of triple-contrast multi-detector computed tomography for detection of penetrating gastrointestinal injury: a prospective study. European Radiology. 2016; 26: 4107–4120.

[15] Malkomes P, Störmann P, El Youzouri H, Wutzler S, Marzi I, Vogl T, et al. Characteristics and management of penetrating abdominal injuries in a German level I trauma center. European Journal of Trauma and Emergency Surgery. 2019; 45: 315–321.

[16] Inaba K, Okoye OT, Rosenheck R, Melo N, Branco BC, Talving P, et al. Prospective evaluation of the role of computed tomography in the assessment of abdominal stab wounds. JAMA Surgery. 2013; 148: 810–816.

[17] Berardoni NE, Kopelman TR, O’Neill PJ, August DL, Vail SJ, Pieri PG, et al. Use of computed tomography in the initial evaluation of anterior abdominal stab wounds. American Journal of Surgery. 2011; 202: 690–695; discussion 695–696.

[18] Choi EJ, Choi S, Kang BH. Indications for laparotomy in patients with abdominal penetrating injuries presenting with ambiguous computed tomography findings. Journal of Trauma and Injury. 2021; 34: 112–118.

[19] SchnÜRiger B, Lam L, Inaba K, Kobayashi L, Barbarino R, Demetriades D. Negative laparotomy in trauma: are we getting better? The American Surgeon. 2012; 78: 1219–1223.

[20] Ertekin C, Yanar H, Taviloglu K, Güloglu R, Alimoglu O. Unnecessary laparotomy by using physical examination and different diagnostic modalities for penetrating abdominal stab wounds. Emergency Medicine Journal. 2005; 22: 790–794.

[21] Bentin JM, Possfelt-Møller E, Svenningsen P, Rudolph SS, Sillesen M. A characterization of trauma laparotomies in a Scandinavian setting: an observational study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2022; 30: 43.

[22] Tang A, Chehab M, Ditillo M, Asmar S, Khurrum M, Douglas M, et al. Regionalization of trauma care by operative experience: does the volume of emergent laparotomy matter? The Journal of Trauma and Acute Care Surgery. 2021; 90: 11–20.

[23] Hietbrink F, Smeeing D, Karhof S, Jonkers HF, Houwert M, van Wessem K, et al. Outcome of trauma-related emergency laparotomies, in an era of far-reaching specialization. World Journal of Emergency Surgery. 2019; 14: 40.

[24] Yucel M, Bas G, Ozpek A, Basak F, Sisik A, Acar A, et al. The predictive value of physical examination in the decision of laparotomy in penetrating anterior abdominal stab injury. International Journal of Clinical and Experimental Medicine. 2015; 8: 11085–11092.

[25] Demirpolat MT, İslam MM. The role of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune inflammation index in predicting the necessity for surgery and therapeutic surgery in patients with anterior abdominal stab wounds. World Journal of Surgery. 2024; 48: 1315–1322.