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Penetrating abdominal wounds. Rationale for exploratory laparotomy.

Over the past decade a general consensus has evolved about the indications for celiotomy after civilian penetrating wounds. Stab injuries to the anterior part of the abdomen clearly warrant a selective approach based on physical signs, local wound exploration, and diagnostic peritoneal lavage. Gunshot wounds violating the peritoneum, on the other hand, mandate abdominal exploration. Peritoneal lavage is also valuable for the selective management of lower thoracic penetrating wounds. Back and flank injuries are difficult to assess, and patient care must be individualized with the assistance of retroperitoneal contrast studies. Although the adjunctive role of peritoneal lavage in the evaluation of penetrating wounds has substantially reduced unnecessary celiotomy, the safest policy is to explore the abdomen if any question of visceral injury exists.