A 28-year-old man sustains a stab wound to the right flank at the level of the 10th intercostal space. On arrival, he is haemodynamically stable (BP 128/82 mmHg, HR 92/min). Abdominal examination shows a single stab wound with no peritoneal signs. FAST is negative. Local wound exploration under local anaesthesia shows the wound tract does not penetrate the fascia. What is the most appropriate next step?

Explanation

## Management of Non-Penetrating Stab Wounds ### Wound Exploration Findings: Local wound exploration is a reliable and cost-effective method to assess penetration in stable patients with flank stab wounds. ### Key Decision Points: - **Fascial penetration absent** → wound does not enter peritoneal cavity - **FAST negative** → no free fluid suggesting intra-abdominal injury - **Haemodynamically stable** → no signs of active bleeding - **No peritoneal signs** → no clinical evidence of visceral injury ### Management Algorithm: When local wound exploration confirms **no fascial penetration** in a stable patient: 1. Observation with serial clinical examination 2. Discharge after 24 hours if patient remains stable and asymptomatic 3. Advise return precautions (fever, abdominal pain, distension, vomiting) **High-Yield Fact:** Approximately 50% of flank stab wounds do not penetrate the peritoneum. Mandatory exploration in all such cases leads to unnecessary laparotomies and morbidity. **Clinical Pearl:** Serial examination is more sensitive than any single imaging modality for detecting evolving peritoneal injury.