ABSTRACT

The management of haemodynamic stable penetrating injuries of the flank has not been well defined; laparoscopic exploration, closed abdominal examination and triple contrast computed tomography (CT) are alternative modalities. Our aims are to explain our experience in these cases.

We reviewed the patients with isolated penetrating flank trauma admitted between January 2003 and April 2013.The flank was defined as the area between the anterior and posterior axillary lines, inferior to the fifth intercostal space and superior to the iliac crest.

There were 118 patients with flank penetrating wounds (9 gunshot and 109 stab injuries). All patients were male. There were three patient groups: laparotomy (13), laparoscopy (16), and only closed clinical observation with triple contrast CT scan (89). The indications for open laparotomy in Group 1 patients were haemodinamically unstable (3/13), gunshot wounds (7/13) and peritoneal irritasyon findings (3/13). In the laparoscopy group two patients had tangential gunshot wound, the others were stab penetrating injuries; five isolated diaphragmatic injuries were repaired laparoscopicaly, two patients with splenic rupture and one patient with colonic injury were converted to an open exploration. There were 8 negative laparoscopies (8/16). Group 3 consisted of 89 (75.4%) patients who were managed with serial abdominal examination and triple contrast CT scan; three of these with negative triple contrast CT were submitted to laparotomy after three days of closed observation (3/89). The mean length of hospitalisation was 8.7 days for Group 1., 3 days for the laparoscopy Group and 3.5 days for the observation group.

In stable, especially stab wound patients, the closed clinical observation with triple contrast CT scan should be performed to minimize the need for laparotomy, and the addition of laparoscopy is useful for evaluation of the diaphragm. (JAREM 2013; 3: 100-2)

Keywords: Penetrating flank trauma, laparoscopy, triple-contrast tomography