“Pop in a scope”: attempt to decrease the rate of unnecessary nontherapeutic laparotomies in hemodynamically stable patients with thoracoabdominal penetrating injuries

Abdominal Self-Stabbing: An Uncommon Type of Sharp Abdominal Trauma

“…Emergency laparoscopy requires the availability of proper technological equipment [21] and a surgeon who is well trained and experienced in laparoscopy [22]. Other limitations of laparoscopy for SI-ASWs are different technical difficulties, such as large blood collections [23].…”

The approach of thoracoabdominal penetrating injury victims by minimally invasive surgery

“…Rabiou et al subjected all the patients to chest radiographs, but in line with the opinion of other authors, in our institution, the imaging of choice for stable patients with TPI is contrast-enhanced computerized tomography (CT) because of the possible identification of the injury tract, of retroperitoneal lesions, and of other signs such as hemo-and pneumothorax. In general, preoperative imaging demonstrates poor accuracy for diaphragmatic lesions; 12,13 nevertheless, CT has a higher accuracy when compared to radiographs, 3 and we advocate for that option whenever possible.…”

“…The authors included patients with injuries below the nipple line or the tip of the scapula; technically, these injuries should be referred to as thoracoabdominal penetrating injuries (TPI), since both the thorax and the abdomen are at risk of having a visceral injury. 2,3 By using the term 'thoracic injuries', the authors may unintentionally mislead readers, and disregard the need for a high index of suspicion for abdominal injuries in such patients -studies show that more than 60% of these patients may present an intrabdominal injury, [2][3][4] and it is for that reason that TPI are among the most challenging situations for the trauma surgeons.…”

“…Stable patients with TPI may present an asymptomatic diaphragmatic injury in up to 67% of the cases. 3,5 Early identification of such injuries is important because of the risk of diaphragmatic hernia and its associated morbidity. 5,6 The optimal route of surgical exploration in such patients is controversial, especially when considering minimally invasive surgery and one aspect that should be noted is the time from admission to operation.…”

“…Patients undergoing minimally invasive surgery within a few hours of admission should be considered for laparoscopy. 3 Those with no abdominal complaints after several hours or a few days from admission may be considered as having low risk of abdominal injury; 5 hence, surgical exploration may focus primarily on the thorax. Rabiou et al approached all patients by video thoracoscopy, but as the timespan from admission to surgery is not mentioned, it is unclear what drove the authors to perform the surgical exploration through the thoracic cavity, and how they excluded intrabdominal injuries in some patients.…”