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Background: The incidence of abdominal stab wounds treated at the Royal Melbourne Hospital, Parkville, Vic., Australia has noticeably increased over the 12 month period to March 2006, mirroring an increase in penetrating abdominal trauma throughout many Australian trauma centres. Management protocols for abdominal stab wounds are still contentious. The current study quantifies the increase in stab wounds at the Royal Melbourne Hospital over a 24 month period and analyses the management modalities used., Methods: A review of the Trauma Unit of the Royal Melbourne Hospital was performed for the period of 20 March 2004 until 20 March 2006. All anterior abdominal stab wounds were collated for the site of injury, investigations performed on admission, results of investigations, operations performed and findings at operation., Results: There were 4244 emergency trauma presentations over the 24 month period between 20 March 2004 and 20 March 2006. The second 12 month period showed a 21.5% increase in overall trauma admissions and a 91.3% increase in anterior abdominal stabbings. The percentage of stab wounds treated conservatively fell by 21.8%, with the percentage of laparotomies increasing by 14.2%. Almost 30% of all patients undergoing surgery had no visceral injury at operation. Twenty CT scans were performed preoperatively, with a sensitivity of 79% and specificity of 100%., Conclusion: Abdominal stab wounds treated at Royal Melbourne Hospital have substantially increased over the past 12 months. Although management is still contentious, a management protocol for anterior abdominal stab wounds is proposed, outlining the role of CT scanning, conservative management, laparoscopy and laparotomy.