127 © Springer Nature Switzerland AG 2020 A. Nasr et al. (eds.), The Trauma Golden Hour, https://doi.org/10.1007/978-3-030-26443-7_23 C. R. Guetter · G. V. Sawczyn · A. Nasr · P. Abreu (*) Iwan Collaço Trauma Research Group, Department of Surgery, Hospital do Trabalhador Trauma Center, Federal University of Parana, Curitiba, Brazil C. Butler Ryder Trauma Center – Jackson Health System, Miller School of Medicine, University of Miami, Miami, FL, USA L. C. Von Bahten Department of Surgery, Hospital do Trabalhador Trauma Center, Federal University of Parana, Curitiba, Brazil A. Marttos William Lehman Injury Research Center, Division of Trauma & Surgical Critical Care, Dewitt Daughtry Department of Surgery, Leonard M. Miller School of Medicine Miami, University of Miami, Miami, FL, USA 23 Penetrating Abdominal Trauma Camila Roginski Guetter, Caroline Butler, Guilherme Vinicius Sawczyn, Adonis Nasr, Phillipe Abreu, Luiz Carlos Von Bahten, and Antonio Marttos Abdominal trauma is common when evaluating a patient in a trauma setting, either in isolation or combined with other injuries. According to the National Trauma Data Bank, the incidence surpasses 90,000 cases in 2013, with a 12.8% mortality rate. Abdominal trauma is classifed according to mechanism, either blunt or penetrating, and each demonstrates different patterns of injury that dictate pathways for evalua- tion and management. In this chapter, we focus on the evaluation and management of penetrating abdominal trauma. 23.1 Introduction Historically, penetrating abdominal trauma would prompt mandatory exploratory laparotomy. However, unacceptably high rates of negative or nontherapeutic lapa- rotomy have led to a change in practice. Incidence of unnecessary laparotomy is reported to range from 23% to 53% for abdominal stab wounds (SWs), and from 5.3% to 27% for abdominal gunshot wounds (GSWs). Complications following