A 40-year-old man sustains a penetrating stab wound to the anterior abdomen at the level of the umbilicus. On arrival, he is haemodynamically stable (BP 125/80 mmHg, HR 95/min). Abdominal examination shows a single stab wound with mild tenderness around the wound. FAST is negative. Local wound exploration under local anaesthesia shows penetration of the anterior rectus fascia. What is the most appropriate next step?

Explanation

## Penetrating Anterior Abdominal Trauma with Fascial Penetration ### Decision Algorithm: When local wound exploration confirms **fascial penetration** in a stable patient: - Peritoneal penetration is confirmed - Intra-abdominal injury status is **uncertain** - Further evaluation is mandatory ### Role of Diagnostic Laparoscopy: **Diagnostic laparoscopy** is the gold standard for evaluating peritoneal penetration and detecting intra-abdominal injury in stable patients because: 1. **High sensitivity and specificity** for visceral injury (>95%) 2. **Minimally invasive** with rapid recovery 3. **Therapeutic potential:** Can repair minor injuries (small lacerations) under direct visualization 4. **Avoids unnecessary laparotomy:** Reduces morbidity in patients without significant injury 5. **Real-time assessment:** Direct visualization of all peritoneal structures ### When Laparoscopy is Indicated: - Fascial penetration confirmed, peritoneal injury uncertain - Haemodynamically stable - No peritoneal signs - Negative FAST ### Conversion to Laparotomy: If laparoscopy reveals significant visceral injury (bowel perforation, solid organ injury), conversion to open laparotomy is performed. **Clinical Pearl:** Diagnostic laparoscopy reduces unnecessary laparotomies by 30–50% in stable patients with penetrating abdominal trauma.