Review of Different Management Modalities of Penetrating Thoracic and Abdominal Trauma

Abstract

n summation, most patients with PAT, especially gunshot wounds, still require surgery. On initial survey, patients who are hemodynamically unstable, have diffuse abdominal pain; evisceration, or peritoneal findings must go to the operating room. Patients with an altered sensorium, head injury, inability to cooperate with serial abdominal exams, or patients who will be undergoing an operative procedure somewhere other than the abdomen may be explored as well, depending on the comfort level of the trauma surgeon. This leaves a clinical subset that can be managed non operatively. In these patients, SNOM can drastically reduce the rates of negative and nontherapeutic laparotomies and result in a cost savings and safety benefit to the patient. Randomized trials would be useful in investigating this topic further but are unlikely to be practical because many patients would be subjected to unnecessary laparotomies for the purposes of the research. The role of CT in elucidating the need for laparotomy after penetrating trauma requires further study; in particular, the role of CT in identifying diaphragmatic injuries needs to be investigated further. Although there is no debate about the need to repair penetrating injuries to the left diaphragm, further study is required regarding the right diaphragm.