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Trauma
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Penetrating Abdominal Trauma
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Most require laparotomy; some stable stab wounds can be observed.
Decision
Outcome
Decision
Penetrating abdominal trauma. Indication for immediate laparotomy?
✓
Hemodynamic instability, peritonitis, evisceration, GI bleeding, impaled object
✓
None of the above (stable stab wound, no peritonitis)
Outcome
Exploratory laparotomy
Decision
Stable stab wound — next assessment?
✓
Local wound exploration; if anterior fascia violated → CT or DPL or laparoscopy
✓
Gunshot wound → laparotomy (high rate of organ injury)
Decision
Workup result?
✓
Free fluid, organ injury, or peritonitis → laparotomy
✓
Negative → admit for serial abdominal exams
Outcome
Serial abdominal exams; CT if uncertain