Penetrating Wounds of the Abdomen: Therapeutic Aspects at the Fousseyni DAOU Hospital in Kayes, Mali

Objective: To evaluate the criteria for therapeutic choice between systematic laparotomy and non-operative treatment "selective abstentionism" in penetrating wounds of the abdomen. Patients and methods: This is a retrospective study performed at the second referral hospital of Kayes from January 1, 2016 to December 31, 2020. We included all patients admitted to the department for penetrating wounds of the abdomen. The parameters studied were visceral injuries, systematic laparotomy, non-operative treatment "selective abstentionism" Results: We collected 66 patients of which 57 were men and 9 were women, i.e. a sex ratio of 6.3. The mean age was 25.6 years with a standard deviation of 28.72 years and extremes (7 years - 60 years). Criminal assault was the main circumstance of occurrence in 34 cases (51%), the vulnating agent was a knife in 38 cases (58%), the site of the lesions was para umbilical in 12 cases (18%), the most eviscerated organ was the omentum in 25 cases (54%). Systematic laparotomy was performed in 41 cases (62%), during this operation the white laparotomy was performed in 6 cases (15%), intraoperatively the wounds of the small intestine were the most frequent in 15 cases (37%), the operative gesture was the simple suture in 24 cases (58%) The morbidity of the systematic operative treatment was 15% (4 parietal suppurations, 2 fistulas of the anastomosis). Mortality was 5% (2 cases). The non-operative treatment "selective abstentionism" was practiced in 25 cases (38%), we had 2 cases of therapeutic failure that required a secondary surgical intervention the lesions in per operative were 1 case of stomach wound and 1 case of wound of the right colonic angle. The morbidity was nil. Conclusion: In the management of penetrating wounds of the abdomen, systematic laparotomy has the advantage of making the lesion assessment while taking into account to avoid the patient a white laparotomy, the non operative treatment must be based on strict selection .......