Do all penetrating injuries to the abdomen require laparotomy?
No. In the era of CT scanning, a hemodynamically stable patient with a negative CT can be observed. Many stab wounds and low-velocity firearm injuries are tangential and do not penetrate the abdominal fascia. However, observation in the setting of multiple trauma can be time-consuming and immediate exploration to rule out injury can be beneficial at times. High-velocity bullet wounds almost always require exploration because of the high likelihood of associated bowel and adjacent organ injury.