In a stab or gunshot wound, is peritoneal violation alone (without any intra-abd. organ injuries) an indication for laparotomy? Previously I was under the impression that any time a non-sterile object is introduced into the peritoneum, it WILL get infected and cause peritonitis, and so you had to wash out the abdomen. However, it seems some stab wounds can be managed conservatively, even if it enters the peritoneum. So what is the general principle here?
The chances are so great, why take the risk of complications and even death.
The answer is absolutely NO.
There are various other factors that are determinants of peritoneal contaminations.
Inherent factors to the patient- preinjury morbidities- DM, Hypertension, Chronic Liver or Kidney diseases etc. Immunosuppressive illness- HIV/AIDS etc.
The Causative factors- The degree of contamination of the penetrating object- Object from gutter or dirty terrains are likely to cause peritonitis but clean object from the home are less likely etc. Gun pellets as example can cause less peritonitis
The driving force determines the degree of penetrations so a fast moving object from a huge blast-bomb are more likely to cause peritonitis.
The list is inexhaustive. Thanks
If the penetrated body of the peritoneum is contaminated, it will pollute the peritoneum and cause peritonitis.
As a General Surgeon, residing in a crisis ridden environment,
I have personally managed several cases of penetrating abdominal wound- Non-operatively. For such patients early; prompt and repeated assessment is mandatory with - CT scan, Focused Assessment with Sonography in Trauma (FAST)- Abdominal and Plain radiograph of the abdomen which showed non-peritoneal or very minimal peritoneal transversations- otherwise adjudged as minimal peritoneal contamination.
The Key to such NON-OPERATIVE CARE is based on 1) patient is hemodynamically stable, 2) Vital Signs like Temp.; Pulse rate and Respiratory rate and BP and other clinical parameters remain normal and stable over and above 72 hours of care.
The decision to embark on OPERATIVE CARE including Laparoscopy (Diagnostic & Therapeutic) or Emergency Laparotomy is hinged on deteriorating overall parameters regarded as Severe Peritoneal contamination== Generalized or Localized Peritonitis as the case may be.
Thanks for the nice question
Not at all, as Marine of War, from the Health Corps, I have seen wounds of this type that have not generated peritonitis: The interaction of several factors is required; obviously, in addition to treating the wound, broad-spectrum antibiotics should be used
I beg a prayer, whatever the beliefs of each one, or a minute of silence for the victims of Beirut ... I had the pleasure of getting to know such a beautiful city and I could not contain my tears in the face of such a tragedy. May the Merciful God have mercy on the deceased and the survivors and allow a speedy recovery for the wounded and for the city!
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