THE INCREASING frequency in urban areas of penetrating abdominal wounds and in suburban and rural areas of blunt abdominal injuries makes trauma one of the leading causes of the acute abdomen in current surgical practice. Trauma represents an accelerated form of general surgery, and the usual criteria of peritoneal irritation and visceral damage should constitute the indications for celiotomy.
To Operate or Not?
Until the end of World War II, suspicion of peritoneal penetration was considered an adequate indication for abdominal exploration. The high incidence of normal findings in these circumstances suggested that approximately one third of patients could avoid operation by selective evaluation of individual cases. Although selective celiotomy requires a larger staff for observation, greater clinical acumen than routine exploration, and modification for local circumstances, the principle is valid. Peritoneal penetration under more controlled circumstances (ie, paracentesis, peritoneal dialysis, closed liver biopsy) is considered routine and safe on
Worth MH. Abdominal Trauma. JAMA. 1976;235(8):853–854. doi:10.1001/jama.1976.03260340057030
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