MANAGEMENT OF PENETRATING WOUNDS OF THE BACK AND FLANK

  • 1 January 1984
    • journal article
    • research article
    • Vol. 159  (6) , 514-518
Abstract
The results of a retrospective and prospective study of patients with penetrating wounds of the back and flank showed that physical examination alone was accurate in 72 and 83%, respectively. The inaccuracy was primarily due to false-negative examinations. The most commonly injured organs were the liver and kidney. The presence of gross hematuria and i.v. pyelography proved to have an accuracy rate of 95% in patients studied prospectively. Peritoneal lavage, although similarly accurate (95%), was associated with a 10% false-negative result when the wound was located in the back. Guidelines for the management of these patients include hospital admission, careful physical examination, urinalysis by dipstick and cell count, i.v. pyelography and peritoneal lavage. Initial hypotension usually is associated with visceral injury and is an indication for exploratory laparotomy. Strict adherence to these guidelines was associated with a negative exploration rate of < 10% and a decrease in the number of patients observed with visceral injury from 50 to 6%.

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