Selective management of 465 patients with stab wounds limited to the posterior abdomen is reviewed. Celiotomy was based primarily on clinical findings. Tenderness not localized to the area of injury and absent or rare bowel sounds best identified patients with serious injuries. Peritoneal lavage and local wound exploration were used infrequently. All fatally injured patients were operated upon or expired within 5 hours of admission. Diagnosis was delayed in three serious injuries: one retroperitoneal colon perforation, and two diaphragmatic lacerations. The colonic and one diaphragmatic injury were identified and treated successfully in the initial hospital admission. The other diaphragmatic hernia was repaired uneventfully 3 months after injury. Eight per cent of the patients never required surgery. Fourteen per cent had significant organ injury. The flank was more vulnerable than the back. The colon was the most common organ injured. Six per cent had "nonessential' celiotomies. The overall morbidity was 11%, and mortality rate, 1.1%. Selective management of posterior abdominal stab wounds is a prudent and reliable approach.