Plaies abdominales avec épiplocèle Abdominal stab wound injury with omentum evisceration

Introduction. – The abdominal stab wound with omentum evisceration, represent 4 to 20% of abdominal injuries. It causes a problem of therapeutic indication between selective and mandatory laparotomy. The goal of this work is to give some answers to this dilemma. Materiel and methods. – A retrospective study from 1992 to 2000, concerning 75 patients presenting an omentum evisceration. Where there were 71 men et four women, the mean age was 25 years old. All the abdominal injuries are exclusively by the stab wound. These 75 patients were divided into three groups: group I: 24 patients (32) were immediately operated ahead of the existence of severity elements; group II: 18 (24%) patients had an isolated omentum evisceration without any elements of severity were operated immediately; group III: 33 (44%) were placed under clinical, radiological and ultrasound control. Results. –We have found four cases of negative laparotomy (16,7%) in group I, and 14 (77,8%) in group II. Five secondary laparotomies (15%) were performed in group III. Among the 51 patients (Group II and Group III) nine (17%) had viscerals injuries... In all of the three groups, there was a high frequency of intestinal organs injuries, there was no mortality and 12% of morbidity. Conslusion. –The isolated omentum evisceration is a penetrating injury of the abdominal wall but not synonym with visceral injuries, the interventionists authors had a high rate of negative laparotomy. However the selectif authors in the asymptomatic patients under clinic examination appears logical: we believe that the laparoscopic diagnostic and therapeutic in doubtful cases can resolve this problem. © 2003 Elsevier SAS. Tous droits réservés. Mots clés : Plaie abdominale ; Épiplocèle ; Traitement