Author: Michael McGonigal

Clinical Practice Guideline
Selective Nonoperative Management of Abdominal Stab Wounds

Hemodynamically unstable?
Peritiontis?
Evisceration?

Yes

Exploratory
laparotomy

No

CT scan chest/abd/pelvis with contrast

Fascial penetration?

No

Home with
instructions

Yes

Obvious / suspected
hollow viscus injury

Yes

Laparoscopy /
laparotomy

No

Serial exam q6°
and serial labs q12°

See serial exam CPG
Obtain WBC and lactate
Normal activity
Do not keep NPO

Repeat CT
with contrast

Gross exam change or lab elevation?

No

Yes

Laparoscopy /
laparotomy

No

Significant change?

Yes

Laparoscopy /
laparotomy

Yes

Equivocal exam change or lab elevation?

No

No

24° observation
complete?

Yes

Home with
instructions

Discharge Instructions
Resume normal activity and diet now
Call If:
Increasing pain in your abdomen
Fever or chills
Loss of appetite for more than a day
Vomiting
Blood in your urine or stool
Discharge from your wound that is not clear or pink
A new bulge in your wound site