TRIAGE BY LAPAROSCOPY IN PATIENTS WITH PENETRATING ABDOMINAL-TRAUMA

Laparoscopy was performed on 33 patients with penetrating abdominal in juries to identify those with peritoneal penetration. Diagnostic or th erapeutic manoeuvres were not attempted; evidence of peritoneal penetr ation mandated exploratory laparotomy. Twenty-two patients had gunshot wounds and 11 stab wounds. Ten patients had multiple penetrating inju ries. Intraperitoneal injury was not evident by clinical assessment in any patient and all were haemodynamically stable. Twenty-three patien ts underwent negative laparoscopy and no intraperitoneal injury was su bsequently detected. Laparoscopy demonstrated peritoneal penetration i n ten patients and subsequent laparotomy detected intraperitoneal inju ries in nine. No complications of laparoscopy occurred. In stable pati ents with penetrating trauma and no clinical evidence of intraperitone al injury, laparoscopy effectively and safely detects those with perit oneal penetration.