World Journal of Surgery

, Volume 37, Issue 5, pp 1162–1168 | Cite as

Patterns of Anterior Abdominal Stab Wounds and Their Management at Princess Basma Teaching Hospital, North of Jordan

  • Abdelkarim Omari
  • Mohammad Bani-Yaseen
  • Mohammad Khammash
  • Ghazi Qasaimeh
  • Fahmi Eqab
  • Hashem Jaddou



With the progressive use of new diagnostic techniques, the management of penetrating abdominal stab wounds is changing. Most studies have been conducted in well-equipped trauma centers in developed countries, and there is a paucity of reports from general teaching hospitals with limited resources. We reviewed the assessment of anterior abdominal stab wounds in patients presenting to our hospital hoping to establish an evidence-based algorithm for managing such patients in busy general hospitals.


The medical records of all 393 patients treated at our hospital for anterior abdominal stab wounds over a 7-year period were reviewed. Information regarding age, gender, site of the stab wound, management, and complications were analyzed.


Twenty-six patients with hemodynamic instability at presentation underwent urgent laparotomy (LAP); 24 (92.3 %) of those procedures were therapeutic. Local wound exploration (LWE) proved that 114 (31 %) of all hemodynamically stable patients had no abdominal fascia penetration and consequently could be discharged home from the emergency department (ED). A total of 253 patients were found to have fascial penetration, and all were admitted for repeat clinical assessments (RCA) and imaging studies. A total of 121 (48 %) of the patients underwent abdominal exploration with 102 (84 %) therapeutic LAP procedures.


Hemodynamic instability and evisceration should continue to prompt urgent LAP. For stable patients, a sequence of LWE followed by focused abdominal sonography for trauma and computed tomography scanning for unclear cases primed by RCA was found to be efficient in limiting hospital admissions and reducing the rate of non-therapeutic LAP.


  1. 1.
    Shaftan GW (1960) Indications for operations in abdominal trauma. Am J Surg 99:657–664PubMedCrossRefGoogle Scholar
  2. 2.
    Lee WC, Uddo JF Jr, Nance FC (1984) Surgical judgment in the management of abdominal stab wounds utilizing clinical criteria from a 10-year experience. Ann Surg 199:549–554PubMedCrossRefGoogle Scholar
  3. 3.
    Demetriades D, Rabinowitz B (1987) Indications for operation in abdominal stab wounds. A prospective study of 651 patients. Ann Surg 205:129–132PubMedCrossRefGoogle Scholar
  4. 4.
    Sirinek KR, Page CP, Root HD et al (1990) Is exploratory celiotomy necessary for all patients with truncal stab wounds? Arch Surg 125:844–848PubMedCrossRefGoogle Scholar
  5. 5.
    Tsikitis V, Biffl WL, Majercik S (2004) Selective clinical management of anterior abdominal stab wounds. Am J Surg 188:807–812PubMedCrossRefGoogle Scholar
  6. 6.
    Ertekin C, Yanar H, Taviloglu K et al (2005) Unnecessary laparotomy by using physical examination and different diagnostic modalities for penetrating abdominal stab wounds. Emerg Med J 22:790–794PubMedCrossRefGoogle Scholar
  7. 7.
    Oreskovich MR, Carrico CJ (1983) Stab wounds of the anterior abdomen. Analysis of a management plan using local wound exploration and quantitative peritoneal lavage. Ann Surg 198:411–419PubMedCrossRefGoogle Scholar
  8. 8.
    Leppaniemi A, Voutilainen P, Haapiainen R (1999) Indication for early mandatory laparotomy in abdominal stab wounds. Br J Surg 86:76–80PubMedCrossRefGoogle Scholar
  9. 9.
    Biffl WL, Kaups KL, Cothren CC et al (2009) Management of patients with anterior abdominal stab wounds: a Western Trauma Association multicenter trial. J Trauma 66:1294–1301PubMedCrossRefGoogle Scholar
  10. 10.
    Nagy K, Roberts R, Joseph K et al (1999) Evisceration after abdominal stab wounds: Is laparotomy required? J Trauma 47:622–624PubMedCrossRefGoogle Scholar
  11. 11.
    da Silva M, Navsaria PH, Edu S et al (2009) Evisceration following abdominal stab wounds: analysis of 66 cases. World J Surg 33:215–219. doi:10.1007/s00268-008-9819-y PubMedCrossRefGoogle Scholar
  12. 12.
    Medina M, Ivatury RR, Stahl WM (1984) Omental evisceration through an abdominal stab wound; Is exploratory laparotomy mandatory? Can J Surg 27:399–401PubMedGoogle Scholar
  13. 13.
    Granson MA, Donovan AJ (1983) Abdominal stab wound with omental evisceration. Arch Surg 118:57–59PubMedCrossRefGoogle Scholar
  14. 14.
    Burnweit CA, Thal ER (1986) Significance of omental evisceration in abdominal stab wounds. Am J Surg 152:670–673PubMedCrossRefGoogle Scholar
  15. 15.
    Huzinga WK, Baker LW, Mtshali ZW (1987) Selective management of abdominal and thoracic stab wounds with established peritoneal penetration: the eviscerated omentum. Am J Surg 153:564–568CrossRefGoogle Scholar
  16. 16.
    McFarlane ME (1996) Non-operative management of stab wounds to the abdomen with omental evisceration. J R Coll Surg Edinb 41:239–240PubMedGoogle Scholar
  17. 17.
    Arikan S, Kocakusak A, Yucel AF et al (2005) A prospective comparison of the selective and routine exploration methods for penetrating abdominal stab wounds with organ or omentum evisceration. J Trauma 58:526–532PubMedCrossRefGoogle Scholar
  18. 18.
    Cothren CC, Moore EE, Warren FA et al (2009) Local wound exploration remains a valuable triage tool for the evaluation of anterior abdominal stab wounds. Am J Surg 198:223–226PubMedCrossRefGoogle Scholar
  19. 19.
    Udobi KF, Rodriguez A, Chiu WC et al (2001) Role of ultrasonography in penetrating abdominal trauma: a prospective clinical study. J Trauma 50:475–479PubMedCrossRefGoogle Scholar
  20. 20.
    Vassiliadis J, Edwards R, Larcos G et al (2003) Focused assessment with sonography for trauma patients by clinicians: initial experience and results. Emerg Med (Fremantle) 15:42–48CrossRefGoogle Scholar
  21. 21.
    Boulanger BR, Kearney PA, Tsuei B et al (2001) The routine use of sonography in penetrating torso injury is beneficial. J Trauma 51:320–325PubMedCrossRefGoogle Scholar
  22. 22.
    Schmelzer TM, Mostafa G, Gunter OL Jr et al (2008) Evaluation of selective treatment of penetrating abdominal trauma. J Surg Educ 65:340–345PubMedCrossRefGoogle Scholar
  23. 23.
    Ramirez RM, Cureton EL, Ereso AQ et al (2009) Single-contrast computed tomography for triage of patients with penetrating torso trauma. J Trauma 67:583–588PubMedCrossRefGoogle Scholar
  24. 24.
    Pham TN, Heinberg E, Cuschieri J et al (2009) The evolution of the diagnostic work-up for stab wounds to the back and flank. Injury 40:48–53PubMedCrossRefGoogle Scholar
  25. 25.
    Demetriades D, Hadjizacharia P, Constantinou C et al (2006) Selective nonoperative management of penetrating abdominal solid organ injuries. Ann Surg 244:620–626PubMedGoogle Scholar
  26. 26.
    Salim A, Sangthong B, Martin M et al (2006) Use of computed tomography in anterior abdominal stab wounds: results of a prospective study. Arch Surg 141:745–750PubMedCrossRefGoogle Scholar
  27. 27.
    Shanmuganathan K, Mirvis SE, Chiu WC et al (2004) Penetrating torso trauma: triple-contrast helical CT in peritoneal violation and organ injury—a prospective study in 200 patients. Radiology 231:775–784PubMedCrossRefGoogle Scholar
  28. 28.
    Roberts JL, Dalen K, Bosanko CM et al (1993) CT in abdominal and pelvic trauma. Radiographics 13:735–752PubMedGoogle Scholar
  29. 29.
    Ahmad N, Whelan J, Brownlee J et al (2005) The contribution of laparoscopy in evaluation of penetrating abdominal wounds. J Am Coll Surg 201:213–216CrossRefGoogle Scholar
  30. 30.
    Lin HF, Wu JM, Tu CC et al (2010) Value of diagnostic and therapeutic laparoscopy for abdominal stab wounds. World J Surg 34:1653–1662. doi:10.1007/s00268-010-0485-5 PubMedCrossRefGoogle Scholar
  31. 31.
    Sitnikov V, Yakubu A, Sarkisyan V et al (2009) The role of video-assisted laparoscopy in management of patients with small bowel injuries in abdominal trauma. Surg Endosc 23:125–129PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • Abdelkarim Omari
    • 1
  • Mohammad Bani-Yaseen
    • 2
  • Mohammad Khammash
    • 1
  • Ghazi Qasaimeh
    • 1
  • Fahmi Eqab
    • 1
  • Hashem Jaddou
    • 3
  1. 1.Department of General SurgeryFaculty of Medicine Jordan University of Science and Technology (JUST)IrbidJordan
  2. 2.Princess Basma Teaching HospitalIrbidJordan
  3. 3.Department of Community MedicineJordan University of Science and Technology (JUST)IrbidJordan

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