Management of Central Abdominal Stab Wound with Hemodynamic Stability

Initial Assessment and Diagnostic Approach

The American College of Radiology recommends performing FAST (Focused Assessment with Sonography for Trauma) immediately as the next step in management for hemodynamically stable patients with penetrating abdominal trauma, as it can be performed rapidly at bedside to detect hemopericardium, pneumothorax, and free intraperitoneal fluid 1, 2
FAST has high sensitivity (0.92) and specificity (0.95-1.0) for detecting hemoperitoneum in trauma patients, including those with penetrating injuries, making it a valuable initial diagnostic tool 4, 5

If FAST is positive, proceed immediately to CT abdomen/pelvis with IV contrast if the patient remains hemodynamically stable to characterize the injury, identify bleeding source, and determine operative versus non-operative management, as recommended by the American College of Radiology 6
If the patient becomes unstable during or while awaiting CT, abort imaging immediately and proceed directly to the operating room based on positive FAST findings, emphasizing the importance of continuous reassessment during the diagnostic workup 6, 3

The American College of Radiology specifically recommends FAST to help triage penetrating trauma patients and direct initial bedside and surgical procedures, due to its rapidity and bedside availability 1, 2
Diagnostic Peritoneal Lavage (DPL) is more invasive and time-consuming than FAST, with no advantage in stable patients, and has been largely replaced by FAST and CT in modern trauma algorithms 4, 5
Immediate laparotomy is not indicated in hemodynamically stable patients without confirmed intra-abdominal catastrophe, and is reserved for hypotensive patients with positive FAST who cannot be stabilized with resuscitation 1, 2, 5

Monitor hemodynamic status continuously, as any deterioration mandates immediate surgical exploration if FAST is positive, highlighting the importance of close monitoring in trauma patients 1, 2, 3
Every 10-minute delay from admission to laparotomy in unstable patients increases mortality, emphasizing the need for prompt and efficient diagnostic and therapeutic approaches 6, 3