Table of contents
Expand All Topics
Penetrating abdominal trauma
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of penetrating abdominal trauma are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2025), the American College of Radiology (ACR 2024,2019), the Surgical Infection Society (SIS 2024), the Surgical Infection Society Europe (SIS-E/GAIS/WSES/WSIS/AAST 2024), the Eastern Association for the Surgery of Trauma (EAST/WTA/PTS 2023), ...
Show more
Diagnostic investigations
Diagnostic procedures
Diagnostic laparoscopy: as per WSES 2022 guidelines, perform local wound exploration or screening laparoscopy to investigate for peritoneal violation, when CT does not identify hard signs of bowel injury, to guide toward a laparotomy or nonoperative management. Discharge patients without peritoneal violation.
B
Show 2 more
More topics in this section
Diagnostic peritoneal lavage
Medical management
Nonoperative management: as per WSES 2022 guidelines, consider offering nonoperative management at specialized centers in patients with penetrating abdominal trauma if the patient is hemodynamically compensated and cooperative. Recognize that nonoperative management might be more suitable for stab wounds when compared to gunshot wounds.
C
More topics in this section
Antibiotic prophylaxis
Inpatient care
Clinical monitoring
As per WSES 2022 guidelines:
Obtain at least 48 hours of serial clinical examinations, performed by consistent specialists or consultants, vital sign monitoring, and serial inflammatory markers testing during nonoperative management.
B
Perform serial clinical examinations as complementary to CT in guiding surgical management in trauma centers practicing nonoperative management approach.
B
Surgical interventions
Local wound exploration: as per WSES 2022 guidelines, perform local wound exploration or screening laparoscopy to investigate for peritoneal violation, when CT does not identify hard signs of bowel injury, to guide toward a laparotomy or nonoperative management. Discharge patients without peritoneal violation.
B
More topics in this section
Bowel injury repair
Specific circumstances
Pediatric patients
As per EAST/PTS/WTA 2023 guidelines:
Consider performing emergency department thoracotomy in pediatric patients presenting pulseless to the emergency department following a penetrating abdominopelvic injury with signs of life.
C
Avoid performing emergency department thoracotomy in pediatric patients presenting pulseless to the emergency department following a penetrating abdominopelvic injury without signs of life.
D
More topics in this section
Patients with diaphragmatic injury
Patients with kidney injury
Patients with ureteral injury
Patients with bladder injury