DIAGNOSIS OF INJURIES AFTER STAB WOUNDS TO THE BACK AND FLANK

Background: Historically, patients with deep posterior wounds underwen t a formal celiotomy to rule out injury, Currently, we use a policy of selective management. The purpose of this review is to evaluate our e xperience with selective management to identify potential areas of fur ther improvement, Methods and Results : This study includes 203 patien ts over a 10-year period, By changing from a policy of mandatory explo ration to selective management the total celiotomy rate decreased from 100 to 24% and the therapeutic celiotomy rate increased from 15 to 80 %. Conclusions: In stable patients, a diagnostic peritoneal lavage sho uld be performed as the initial diagnostic study. When diagnostic peri toneal lavage is negative, triple contrast computed tomography should be performed to evaluate the remaining retroperitoneal structures. Any suggestion of pericolonic extrayasation of contrast or air, edema, or hemorrhage must be interpreted as a positive study and prompt conside ration for operative exploration.