Page 24 - Delaware Medical Journal - March 2017
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FIGURE 3
Operative photo showing port sites and incisional umbilical hernia.
FIGURE 4
Operative photo showing non-traumatic grasper retrieving projectile from hematoma cavity within midline adhesive disease.
selective non-operative management of penetrating abdominal trauma.2 These guidelines apply to low velocity penetrating wounds such as stab wounds, employing serial clinical examinations for patients who remain hemodynamically normal but have violation of the fascia/peritoneum on local wound exploration or computed tomography of the abdomen. Such practice management guidelines have not yet been widely adopted in patients with high velocity penetrating abdominal wounds. This is likely due to the historic rate of intra-abdominal injury requiring operative intervention, exceeding 90 percent when peritoneal violation has occurred.3
In contrast to non-operative management, diagnostic laparoscopy has begun to gain traction in hemodynamically normal patients presenting with both anterior abdominal stab wounds as well as gunshot wounds. Chestovich and colleagues recently published
a retrospective review in which it was shown that diagnostic laparoscopy with therapeutic intervention could be used safely in
select patients meeting the aforementioned criteria.4 While only a small sample of these patients sustained high velocity penetrating wounds, their data showed promise for application of diagnostic diagnostic laparoscopy can be seen in instances where computed tomography fails to clearly determine the presence of hollow viscus injuries as well as diaphragmatic injuries.5,6
In this case report, the patient presented with hemodynamic stability after sustaining a high velocity penetrating abdominal wound. As presented, computed tomography provided As has been shown in the setting of abdominal stab wounds, diagnostic laparoscopy was clearly able to determine the degree, or lack thereof, of intra-abdominal injury. In this case, laparoscopy avoided what would ultimately have been a non- therapeutic laparotomy, while allowing for inspection of the peritoneum with retrieval of the offending missile. The ability
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Del Med J | March 2017 | Vol. 89 | No. 3
